| Please send me ____ tickets @ $50.00 each. |
| Name: ___________________________________________________ |
| Address: _________________________________________________ |
| ________________________________________________________ |
| City: ________________________ State: ______ Zip: _____________ |
| Phone: _________________________ Email: ____________________ |
| ____ I have enclosed a check/money order in the amount of ___________ |
| ____ Please use my Visa/Mastercard. Exp.date _________ |
| Account# _________________________________________________ |
| Signature _________________________________________________ |
| |
| Send form to: Thomas Merton Center
Attn: Ida B. Wells Celebration
5125 Penn Avenue
Pittsburgh, PA 15224 |
| |
