Text Box: If paying by check, Visa or Mastercard:   Print this page, complete the form and send it with your payment to:   Charles Perdew Museum Association PO Box 103 Henry, IL  61537   If paying online with Visa or MasterCard:   Go to the Contact Us page on our website and indicate in the comments section that you want advance tickets to the Dinner & Auction, state the number of tickets you wish to purchase and then complete the remainder of the form, or call us at 309-364-3279.

Annual Dinner & AuctionText Box:   Name:  _______________________________________   # of Tickets: ___________________     Address:  _____________________________________  Amount Enclosed: $______________       City:  __________________________________  State:  ____________  Zip:  ______________     Telephone:  _______________________________  Email:  ____________________________     Credit Card Number:  ___________________________________  Expires:  _______________

Text Box: October 23, 2009 at 5:00 PM Henry, Illinois Ticket Donation  $20 each

Text Box: Please note that you will receive your tickets by US mail in approximately 10 days after receipt of payment.

See you at the Dinner!Text Box: Charles Perdew Museum Association PO Box 103 Henry, IL  61537 309.364.3279 info@charlesperdew.com

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