Request For Information On The Old School House Project 
















 
 
                                                         Name
                                                         Address
                                                         Address 2/P.O. Box
                                                         City
                                                         State
                                                         Zip Code
                                                         Day Phone
                                                         Evening Phone
                                                         Email
 
                                                       # of Combined Dinner/Raffle Tickets ($35 each)
                                                    
                                                       # of Raffle Tickets Only ($10 each or 3 for $25)
 
                                                         I am paying by CHECK (enclosed) 
                                                         I am paying by CREDIT CARD (information included below)
 

                                                       Credit Card Type
                                                       
                                                       
                                                       Credit Card Expiration Date
                                                       
                                                       
                                                       Card Number
                                                       Name on Card
 
                                                       Comments:
                                                       
 
                                                       CLICK HERE TO PRINT THIS PAGE!
Fill out the information below, click "PRINT THIS PAGE" at the bottom when you are done and send this page to:
 
Saugatuck-Douglas Historical Society
P.O. Box 617
Douglas, Michigan  49406-0617
 
Be sure to include your check if paying by check.
Your tickets will be mailed to you via U.S. Mail.
 
This form is not being sent online - you MUST fill out the information, print this page and mail it directly to the Society.
 
Saturday, March 15, 2008  |  Coral Gables  |  6:00 - 9:00 p.m.
Dinner  |  Silent & Live Auction  |  Cash Bar
Raffle for Two for a Week's Trip to Ireland
 
The Saugatuck-Douglas Historical Society
P.O. Box 617
Douglas, Michigan  49406-0617
PUB PARTY TICKET PURCHASE FORM