TICKET ORDER FORM

15^th Westover Autumn Pilgrimage

Westover Church

Charles City, VA

Contact Name:   Mr. Mrs. Ms.

 (Last)                                                                (First)                                                               

Address:  

Phone:  Day          Evening       Cell

E-mail:    Add to Westover Pilgrimage mailing list? Y or N

Form must be postmarked by September 22, 2009

Number of tour tickets: _______ @ $30 per person                                  =           $ __________

Number of box lunches: _______ @ $12 per person                                 =           $ __________

Number of raffle tickets: _______ @ $5 each or Six for $25                    =           $ __________

TOTAL AMOUNT                                                                                      =           $  __________

To Purchase Tickets

Make check payable to Westover Church

Mail check and form postmarked by September 22 to

Teresa Coyne

13101 Tyler’s Mill Road

Charles City, VA  23030

(804) 829-9077

westoverpilgrimage@yahoo.com for more information