Logo_jra  Japanese Restaurant Association of Southern California  
 

 

JAPANESE FOOD FESTIVAL ADVANCE TICKET APPLICATION

 

NAME :   DATE :

ADDRESS :

CITY :     ZIP CODE :

TEL :           FAX :

E-MAIL ADDRESS :

 

> > > PAYMENT :

   NUMBER OF JOINT: x $50.00 = TOTAL AMOUNT : $

    : PERSONAL CHECK      OR, : MONEY ORDER

    CREDIT CARD:

: VISA,      OR,      : MC

CARD : # - - -
     ---- pin #:

EXPIRE DATE : /

CARD HOLDER NAME :

 

    SIGNATURE : ______________________________________________________

* Please order now !


 
         -----> MAIL TO: 312 East First Street Suite 340, Los Angeles, California 90012
       Tel : (213) 687-4055 * Fax : (213) 687-4110 * Email : jra@jrasc.com * www.jrasc.com