Jackson Day 2010 • April 16-17

Name _____________________________________________ Phone _______________________ Email ___________________________ Address __________________________________ City _______________ State _____ Zip ______ Occupation ________________________ employer ______________________________________

Order Form for Jackson Day 2010 Tickets

All events (unless noted) will take place at:CLARION HOTEL3333 S. Glenstone • Springfield MO 65804Toll Free 800-756-7318 • Local 417-883-6550

(Please communicate directly with the hotel to make reservations.)

Cost: Per day per room is $74.00 for a single/double room plus tax (11.93%.)

http://www.clarionhotel-spfld.com/________________________________________________________________________________________________

Interested in donating auction items?Contact Madelyn Schnick @ Democratic Headquarters - 417-886-8980

Paid for by The Greene County Democratic Central Committee, Ann Dare, Treasurer.

Ad Deadline is March 27. Call 865-6333 or email jacksondayads@gmail.com for sizes and information.

All other tickets may be picked up at the registration table at Jackson Day after 5:00 p.m. Friday and all day Saturday before 6:15 pm.

Please list the names of all in your party as you wish them printed on the name tags ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ If you live outside Greene County and wish to have your tickets mailed to you, please enclose a self-addressed, stamped envelope. The tickets will be mailed 2 weeks before Jackson Day.

_________ # of Sponsor Tickets @ $200 each.___________

This includes all Friday events and Saturday events: Alliance Breakfast, Sponsors' afternoon activitiesof luncheon and cocktail party with the Banquet speaker, and prime seating at the Banquet.

_________ # of Saturday evening Banquet tickets @ $50 each.$___________________ # of Saturday morning Alliance Breakfast tickets @ $25 each.$___________________ Jackson Day Program Book AdsFull Page$400$__________Half Page$220$__________Quarter Page$120$__________

Limited booth space available

TOTAL:

$_________

Make checks payable to the

Greene County Democratic Central Committee

Visa

Mastercard

DiscoverCredit Card Number: __________________________ Exp. Date __________________ CVV2 Code _________

Billing address of credit card if different than listed above

Address __________________________________ City _______________ State _____ Zip ______

The Jackson Day Committee will also be conductinga food drive

for Ozarks Food Harvest & will be acceptingnon-perishable goods throughout Friday and Saturday.