Name(s):

Address:

City/State/Zip:

Telephone:

Email:

Number of Tables of 8 Purchased:    @ $680 per table
 If purchasing a table(s), please list the names of the other guests you're inviting to sit at your table:

Number of Individual Tickets Purchased:   @ $85 per person

Are there people attending the event that you would like to sit with, if possible?  Yes     No

If yes, please list the names:

Total Payment Due:  $
 

Payment Options:

  Credit Card:    Call the CVSM office (717.261.1220) and give your credit card information to the CVSM office staff,
                                                       and tell them you've made an online Dinner Dance Reservation.

  Check:  Mail to CVSM, 1015 Philadelphia Ave., Chambersburg, PA 17201 (In the memo field, please write "DD10 Online Reservation")
 

Once the reservation and payment are received, you will receive a confirmation letter from CVSM.
Please note that no reservation can be completed until payment is received.  Thank You!

We look forward to seeing you there!