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Register here for the 2011 Grand Ball

Fields marked with * are required.

*First name:
*Last name:
*Address:
*City:
*State:
*Zip Code:
*Phone: - -
*E-mail address:
Individual tickets:
($110 each
through August 10)		 (Enter number of tickets)
Retired and Active
SPPD and guests:
($55 each
through August 10)		 (Enter number of tickets)
Vegetarian meals preferred: (Enter number of meals to be vegetarian)
Payment is for:
(List names)
Donation to Saint Paul
Police Foundation: 		$ .00 (This is in addition to ticket purchases)
*Credit card type:
(Select one)
*Credit card number: (XXXX - XXXX - XXXX - XXXX)
*Credit card expiration: /
*Card Verification Code:     (last 3 digits on the back of your credit card)
*Name of Credit Card Holder
(as it appears on billing):
*Billing Address
of Credit Card:
*Billing City
of Credit Card:
*Billing State
of Credit Card:
*Billing Zip Code
of Credit Card:
Please try to seat me with the following (Tables of 10):
#1: #2:
#3: #4:
#5: #6:
#7: #8:
#9: #10: