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2nd Annual Chai Lifers Picnic & Ice Cream Social

* Full Name

* Phone Number

Individual Ticket

Family Pack Ticket

Ice Cream Flavor

	Double Chocolate Chip
	Black Raspberry Chocolate Chip
	Buckeye Blitz
	Lemon Sorbet
	No ice cream, thank you

*E-mail

*First Name

*Last Name

Account

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the payment amount by 3% to cover credit card fees (No fee for Checking)

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