Untitled - Lenox Hill Neighborhood House
Untitled - Lenox Hill Neighborhood House
Untitled - Lenox Hill Neighborhood House
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SHALL WE DANCE?<br />
PLEASE MAKE CHECK PAYABLE TO<br />
<strong>Lenox</strong> <strong>Hill</strong> <strong>Neighborhood</strong> <strong>House</strong><br />
OR CHARGE TO<br />
AMERICAN EXPRESS MASTERCARD VISA<br />
ACCOUNT<br />
EXP. DATE<br />
SECURITY CODE<br />
SIGNATURE<br />
NAME<br />
(NAME AS YOU WOULD LIKE IT LISTED IN THE PROGRAM)<br />
ADDRESS<br />
CITY STATE ZIP<br />
DAYTIME TELEPHONE<br />
EMAIL<br />
MY COMPANY WILL MATCH MY GIFT. ENCLOSED IS A<br />
COMPANY FORM.<br />
IF PURCHASING MORE THAN TWO TICKETS, PLEASE LIST<br />
YOUR GUESTS’ NAMES.
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