Harvest Moon Festival

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1 Welcome

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$20.00 – Harvest Moon

Guests

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$0.00 – Harvest Moon Kids 12 & Under

Guests

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Guest 1		First name* Last name* Email* Phone (daytime)*
Guest 1		First name* Last name* Email* Phone (daytime)*

Phone (daytime) *
If bringing Carload, how many people are in your party?

Sub Total	$0

Donations	$0

Taxes	$0

50% Deposit	$0

Due Now	$0 $0

Remaining Balance	$0

First Name
Last Name
Card Type
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card

Wisdom. Service. Community.
952 Bethany Tpke, Honesdale, PA 18431 USA
800 822 4547
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