ORDER FORM
1 .
2 .
3 .
4 .
Name
Address
City
State
ZIP
Daytime Phone
Evening Phone
Email
 
Check here if you would like to receive information about Civic Orchestra and Symphony Center events via email.
CONCERT DATE
NUMBER OF TICKETS
Six-ticket maximum per concert
Monday, October 7, 8:00
Tuesday, November 19, 8:00
Tuesday, January 21, 8:00
Monday, February 17, 8:00
Monday, April 7, 8:00
Monday, May 19, 8:00
Wednesday, June 4, 8:00
Total number of tickets
Total number of tickets x $2 = TOTAL SERVICE FEE
$
Contribution to Civic Annual Fund
$
TOTAL
$
General Admission
In order to assist with operating costs, the Civic Orchestra charges a nonrefundable $2 per ticket
service fee.
Donors who select a Reserved Prime Seating option do not need to complete this section
,
unless additional single tickets are desired.
Card Number
Expiration Date
Cardholder's Name (please print)
Signature
Payment Information
Please do not send cash.
Enclosed is my check made payable to the Civic Orchestra of Chicago.
Please charge my:
American Express
Visa
MasterCard
Discover
Reserved Prime Seating
I would like to contribute
$75
and receive 4 vouchers redeemable for Lower Balcony seats.
I would like to contribute
$150
and receive 8 vouchers redeemable for Lower Balcony seats.
I would like to contribute
$300
and receive 12 vouchers redeemable for Lower Balcony seats.
I would like to contribute
$500
and receive 18 vouchers redeemable for Lower Balcony seats.
I would like to contribute
$1,000
and receive vouchers redeemable for 2 Box seats for the entire season.
I would like to contribute a different amount of
$
TOTAL CONTRIBUTION =
$
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