Ukrainian Day at Giants Stadium

Ticket Order Form

Please include the following information with your payment.

Make all checks payable to: UCCA NJ - Festival

Please note that the tickets will be mailed to the address provided below, unless picked up in person (see box at bottom).

Name _______________________________________________________

Address _______________________________________________________

City ________________________________ State ________________

Zip ________________________________

Contact Telephone # ___________________________________________

E-mail Address ___________________________________________

# of Tickets requested ($26 each) ________________

Check amount (# of tickets x 26) $ _______________

$5 per each ticket sold will be donated to a fund to foster sports and cultural activities with Ukraine, and an additional $5 of each ticket sold will be donated to an established domestic Ukrainian youth or sports group, or church organization, in the United States (Examples: Plast, Cym, Sitch, Krylati, CCRF, etc…)

Please let us know which bona fide US-based Ukrainian charitable, religious, cultural, civic, athletic or youth organization you would like the $5 proceeds from YOUR tickets to go to:

ORGANIZATION: ____________________________________________________________

ADDRESS: ____________________________________________________________

Please mail this form, along with your payment to:

Ukrainian Day at Giants Stadium P.O. Box 87 Maplewood, NJ 07040 Checks made payable to: UCCA NJ–Festival

*Check box and sign below ONLY for tickets purchased and obtained in person.

By checking this box, SIGNATOR confirms that they have physically received the specified number of tickets ordered above and the transaction is completed.

Signature x ____________________________________________________

Name of person / outlet from whom tickets were purchased: _________________________