The As The World Turns Fan Club Luncheon Order Form

Name:________________________________ Member_____Non-Member_____New Member_____

Address:___________________________________________________________________________________

Email Address: _____________________________

Home Phone:___________________ Cell Phone: ______________________

Number of tickets____________ Amount Enclosed $ _______________

Please list all names in your party

1. __________________________________ Member _____ Non-Member _____ New Member _____

2. __________________________________ Member _____ Non-Member _____ New Member _____

3. __________________________________ Member _____ Non-Member _____ New Member _____

4. __________________________________ Member _____ Non-Member _____ New Member _____

5. __________________________________ Member _____ Non-Member _____ New Member _____

6. __________________________________ Member _____ Non-Member _____ New Member _____

7. __________________________________ Member _____ Non-Member _____ New Member _____

8. __________________________________ Member _____ Non-Member _____ New Member _____

9. __________________________________ Member _____ Non-Member _____ New Member _____

10.__________________________________ Member _____ Non-Member _____ New Member _____

If more names please use back of form. All names must be included or Non-Member fee will be charged.

PLEASE DO NOT STAPLE MONEY ORDERS TO FORM!