2012 Lighthouse Gala Ticket Form

Please Print:

I/ We will attend, please reserve # _____ tickets at $45.00 per person: $____________

___ Check Payable to American Lighthouse Foundation enclosed, or

___ Charge my Visa, MasterCard, Discover or American Express

# ______________________________________ Exp Date: __________ CVV#______

Signature: ____________________________________________________

Attendee Name(s): ______________________________________________________

                                  ______________________________________________________

Address: _____________________________________________________________

                  _____________________________________________________________

City: ____________________________ State:___________  Zip: ________________

Phone: _______________________________________________________

Email: ________________________________________________________

Mail  completed form with payment to:

American Lighthouse Foundation

PO Box 565,

Rockland, Maine 04841

Phone: 207-594-4174

Tickets, directions & other information  will be mailed about 2 weeks prior to event, space is limited so make your reservations early!