Ormond Memorial Art Museum & Gardens
Day Trip Reservation Request
Trip Name & Date    
Name    
Address    
City, State, Zip  

_____________________________________
City

____
State

________
Zip
Telephone   Number   

(            ) ________ - ___________________
 Area Code

Number Attending  ______  X Cost per person $______ = Total  Due $_______

Enclosed is my check number

________

in the amount

$____________________

Bill my credit    
card:   

   O MasterCard   O Visa   O American Express

Card Number:   

  __________-__________-_________-_________-_________

Expiration Date:   

  ____________ / ____________ (Month / Year)

Name as it    
 appears    
on card:    

 ____________________________________________ (Please Print)

Signature:   

  _____________________________________________________

Mail form to OMAM, 78 E. Granada Blvd, Ormond Beach, FL 32176
Questions? Call (386) 676-3347
OMAM is a U.S. Code Title 26 Section 501(c)(3) non-profit organization,
registered with the State of Florida Department of Agriculture and Consumer Services.
Registration Number: SC07333.
Website Design Copyright © 2002-2004 Black Cat Web Productions All rights reserved.
This web page was updated on 29-Sep-2004 02:08 PM -0500