Untitled Document

Barber Ball Reservation:

*Yes, I/we plan to attend. I would like : at $90.00 each = $asd
Please Complete with attendee's information:
*First Name:
*Last Name:
* City:
* State:
* Zip / Postal Code:
*Phone #:
* E-mail:
Select One:
We do not have a seating preference, please seat us.
Please seat us at the table reserved in the name of
Corporate Sponsorship - Includes a table of ten, website promotion and recognition at the event
Gold Level - $5,000
Emerald Level - $2,500
Tickets are not issued. Please indicate how you would like to receive confirmation of your reservation and seating.
If you are purchasing tickets for other guests at this time, please specify their names below separated by a comma.

Coupon Code:
In addition, I would like to make a tax-deductible contribution:
Founder's Gift $1000.00
Benefactor $500.00
Patron $300.00
Supporter $200.00
Friend $100.00
Other Amount   $
This information is the same as my billing information.

Credit Card Information:

Total Transaction Amount: $xx.xx
* Credit Card Holder Name:
Is this a company credit card?: Yes
If so, please list the company:
* Address:
* City:
* State:
* Zip / Postal Code:
* Phone #:
* E-mail:
* Card Type:
* Card Number:
No dashes or spaces.
* Expiration Date: /
* Security Code (CCV):


Guests can also make a reservation to the Barber Christmas Ball by mailing payment with the reservation form.  Please download the Reservation/DonationForm and mail with check made payable to the Dr. Gertrude A. Barber Foundation.
Mail form and payment to:
Barber Christmas Ball
Barber National Institute
100 Barber Place
Erie, PA  16507