Just print this registration form, complete it, and mail with full payment to the address below.

Mail this completed form with full payment to:

A Night In The Orient
Al Malaikah Shrine 665 W. Jefferson Blvd., Los Angeles, CA 90007

A Night In The Orient Saturday October 5th, 2002 4:30 pm to 10:00 pm Shrine Convention Center 665 W. Jefferson, Los Angeles I want to order (number)_____ tickets @ $12.50 each = Total of $ _________ Name: ___________________________________________________________ _________________________________________________________________ Address:______________________________________ City _______________ State _______________ Zip _________ Home Phone_____________________ Unit/Club________________________ Amount: Enclosed: $_____________ Credit Card: Visa__Master Card__AMEX __ Credit Card #________________________________ Expiration Date ___ / ___ Signature__________________________________________________