INSTRUCTIONS:

You may fill out this form, save it and return it via email to marti@wespark.org …

OR print it out, fill it in and fax it back to 818-906-3021…

OR, if you wish to pay by check, fill it the contact information and mail it back to:

Marti Baer, weSPARK, 13520 Ventura Blvd, Sherman Oaks CA 91423

weSPARK Cancer Support Center Event Registration Form

EVENT/DATE

Burton Sperber presents “A Magical Night II” at the Magic Castle

Monday, July 13, 2009



NAME :

STREET:

CITY, ZIP:

PHONE:

EMAIL:

# OF TICKETS:

AMOUNT EACH $250.00

TOTAL AMOUNT BEING CHARGED:

CREDIT CARD TYPE:

CREDIT CARD NUMBER:

CC EXP DATE:

weSPARK, Inc. is a 501(c)(3) charitable organization.

IRS tax-exempt number: 95-4785462.

Please make check payable to: weSPARK, Inc.