YES, WE WILL ATTEND THE RUSSIAN NEW YEARS EVE DANCE!
PLEASE PRINT OR TYPE.
NAME:__________________________________________
PHONE: (_____)_________________
E-MAIL: _______________________

ADDRESS: ________________________________________________
CITY: ______________________________
STATE:_______ ZIP CODE: ____________

          Tickets will be mailed via regular mail to the above address. No P.O. Boxes.
We will have  ___________  people attending.
Make our reservations in he name of: ________________________________
PLEASE PRINT OR TYPE.
Orders January 3, 2003 or before:
# of people __________ X $20.00 =$__________

A Check or Money Order in the amount of $__________  is enclosed with this form.
Orders January 4, 2003 or later:
# of people __________ X $25.00 =$__________

A Check or Money Order in the amount of $__________  is enclosed with this form.
Make Checks & Money Orders payable to:

F.A.N. Club, Inc.
10670 Blossom Avenue
Parma Heights, Ohio 44130
PRINT THIS FORM AND MAIL WITH YOUR PAYMENT!
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