Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Referred/Sold By:
Products
*
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( X )
EVENT TICKET
$
60.00
Quantity
I happily agree to donate the processing fee of $1.10 per ticket so 100% of my ticket purchase goes to MANA de Metro Detroit.
$
1.10
Quantity
Item subtotal:
$
0.00
Full Page Ad
$
100.00
(5” x 7.5”)
Half Page Ad
$
50.00
(5” x 3.75”)
Business Card Ad
$
25.00
Patron Ad
$
10.00
Your name will be listed in the program
Total
$
0.00
Submit
Should be Empty: