THE KENNET SQUARE LIONS
TICKET ORDER
FOR
Roses and Chocolate
Name:_____________________________________________
Address:___________________________________________
City:________________________ST_______ZIP__________
Phone: ______________________Phone:_________________
Email:______________________________________________
Number of Dozen  ________ X $40 = ____________________
Number of Chocolates_______ X $40  =__________________
TOTAL ENCLOSED:                                           =__________
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