2020 Memory Page Form
COMPLETE THIS FORM AND SEND IN BY APRIL 8TH.
Full Page ($190)
Full Page ($190) + ______ extra pics at $5 per pic
Picture to use for Ad (Get number from
or from photographer once you meet with him to view your photos)
1/4–Page Ad Text (max.120 characters)
Full Page Ad Text (max. 300 characters)
Sponsorship (Business Card) (must be turned in to office with this form)
Payment Card Number (This field is encrypted)
Card Expiration Date
Amount to be ran
Date you want card to be ran
Email Address to send receipt to
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This form was created inside of Beverlys Dance.