Ben DeLa Vega's

27th Annual Black and White Ball
Friday, October 18th, 2019
7:00 p.m - 11:45 p.m.

Reservation Form
Name: __________________________________________
Address: _________________________________________
City: ___________________ State: ____ Zip Code: ________
Daytime Phone: ____________________
Evening Phone: ____________________
E-Mail: ______________________________________
Event fee $140/person x Number attending ______ Total Remittance = $__________

* Special Event Tickets are non-refundable. All sales are final *

Please R.S.V.P. your attendance by October 10th, 2019

Please make checks or money order payable to: Ben De La Vega
Address: 940 East Beltline Road, Suite 132, Richardson, Texas 75081
For further info: Call Ben at 972.231.7433 or PJ at 972.693.7651
or Email: pj.dancetique@sbcglobal.net / Website: www.pjsdancetique.net


*We appreciate your support*