Name:________________________________________________________________________



Address: ________________________________________________________________________

             


Phone:_______________________________ Email: ___________________________________

To purchase:

• Print this page

• Complete form

• Make check to: “Lakeside Dance Club”

• Mail form & check to:


Jerry & Jeanne Miller

664 Nemec Estates Rd SW

Alexandria, MN 56308


        320.763.7932

Email the Summer Dance Club danceclub@lakesideballroom.org

Dance Club Gift Certificate Order Form

Number of Certificates _____ Amnt of Certificate______Amnt of Check _______Date ____________

Mail Certificates to:

Office Use

Dance Date Purchased: ____________   Date Mailed: ___________  Date Redeemed:____________ Cert # _________

Gift Certificates make a great gift for Holidays, Birthdays, Anniversaries and special thank-yous.  Gift Certificates are also available for purchase during scheduled dances.

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