Name:________________________________________________________________________
Address: ________________________________________________________________________
Phone:_______________________________ Email: ___________________________________
To purchase:
• Print this page
• Complete form
• Make check to: “Lakeside Dance Club”
• Mail form & check to:
Email the Dance Club danceclub@lakesideballroom.org
Dance Club Gift Certificate Order Form
Number of Certificates _____ $ amount of Certificate ______ 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.
Street City State/Zip
Lakeside Dance Club
Barbara Benson
508 East Lake Cowdry RD NW
Alexandria MN 56308