On-Line Registration
for
WHYY Celebrates Philly Jazz

Benny Golson Quartet
Saturday January 20, 5:30 pm
Independence Seaport Museum

Attending
 Cost
Sub-Total

Member@$25
$

Non-member @ $40

$

Student @ $20

$

Senior @ $20
$
----------
 Total
$
----------
 I would like to become a member
$ 40.00 (please add)
----------
 Total Amount Enclosed
$

 

Name
Address
City State Zip
Daytime Phone
Fax
 
E-Mail Address (e.g., yourname@domain.com)
Payment method MasterCard     Visa     Discover     American Express     Check (see below)
Name on card Expiration Date  
Card Number
All tickets are for reserved seating.
Tickets purchased by January 10, 2001 will be mailed.
Tickets purchased after that date can be picked up beginning at 5:00 PM, January 20, 2001.
Please call WHYY at 215-351-2084 if you have any questions. Thank you.

Another way to register!
(Please make checks payable to WHYY)
Print out form and mail registration form and payment to:
Blake Lehmann
WHYY
150 North Sixth Street
Philadelphia, PA 19106

If mailing, make sure to include Authorized signature!


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