1. DVD Order Form All School Concert 2016 $40 Each
______ Total Copies for Friday, 6/ :30pm Performance
______ Total Copies for Saturday, 6/ :00pm Performance
______ Total Copies for Saturday, 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