SALAAM SHRINE CIRCUS 

TICKET ORDER FORM

Name ___________________________________________________

Address__________________________________________________

City, State Zip______________________________________________

Telephone Number__________________________________________

E-Mail ___________________________________________________

Please check date and time below:                    Number of Tickets

                                                      General Admission            Reserved Seating

q          Thursday   5/15 11:00 AM                           ________                             ________

q          Thursday     5/15   7:00 PM                          ________                             ________

q          Friday           5/16 11:00 AM                         ________                             ________

q          Friday          5/16   7:30 PM                           ________                             ________

q          Saturday     5/17   2:30 PM                          ________                             ________

q          Saturday      5/17   7:30 PM                         ________                             ________

q          Sunday        5/18    1:00 PM                          ________                             ________

q          Sunday        5/18    5:00 PM                          ________                             ________

                                         Total Tickets:      ________                             ________

                                       Price Per Ticket:    X $11.00                               X $16.00

                                          Total Amount:     ________                             ________ 

Mail to: Salaam Shrine Circus, 369 East Mt. Pleasant Avenue, Livingston, N.J. 07039

 q   Visa and q  Master Card Accepted

_____________________       _____________________         _______________

        Name On Card                                   Card Number                                  Exp. Date

I authorize Salaam Shrine Circus to charge my credit card for the total amount.  

_______________________________________

Cardholder Signature

NO REFUNDS OR EXCHANGES

Please detach and retain bottom portion for your records.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  

   Number of Tickets ordered: __________  Total amount of order:  _______

            Method of Payment:     q   VISA       q    MC    q    Check

            Date Sent:   __________                                    Check No. ________

 SALAAM SHRINE CIRCUS 

TICKET ORDER FORM

369 East Mount Pleasant Avenue, Livingston, n.j. 07039-1597