DVD Order Form All School Concert 2016 $40 Each ______ Total Copies for Friday, 6/3 6:30pm Performance ______ Total Copies for Saturday, 6/4 2:00pm Performance ______ Total Copies for Saturday, 6/4 6:30pm Performance ______ Total Copies for Saturday, 6/18 Dance Connection Recital Total Amount Due: $ ___________ Dancer’s Name: _________________________ Phone #: ( ) ____-______ Class: _______________________ Teacher: ________________________ Location: Main Centre Payment Method: Check \ La Mesa Cash Liberty Station Credit Card Visa/MasterCard #: __________________________ Name on the Card: ___________________________ Exp Date: ________ 3 Digit Code: ______ Billing Zip Code: _________ This form with payment must be returned no later than Saturday, June 18, 2016 DVDs will be available for pick up at the school in August. Date Paid: ________________ Amount Paid: ________________ Receipt Number: ________________ Received DVD: Signature: _____________________________ Date Received: ________________ For Office Use Only