Just print out this form, fill it out, and mail it with your check to:

Macy DeLong, Executive Directior
Solutions at Work
P.O. Box 391349
Cambridge, MA 02139

Name:__________________________________________________

Address:________________________________________________

City:_________________________State:__________Zip:_________

Phone:______________________________________

Email:_______________________________________

Number of Tickets:

_____ Individual: $45

_____ Couple: $80

_____ Student: $25

I would like to make a tax-deductible donation of ______ additional tickets at $45 each to enable Solutions at Work program participants to attend the dance.

Total Cost of Tickets: $____________

Please accept my tax-deductible contribution of $_______ to support the programs of Solutions at Work.

I have enclosed my check payable to Solutions at Work in the amount of: $___________

No tickets will be mailed; all guests will be listed at the event reception desk.