​                                               TO CONTACT US OR ORDER TICKETS

  TO ORDER DERBY OR  50/50 TICKETS PLEASE PROVIDE THE REQUESTED INFO:           
NAME:         ENTER NAME OF PERSON ORDERING THE TICKETS 

EMAIL:        ENTER EMAIL OF PERSON ORDERING THE TICKETS 
SUBJECT:   INDICATE WHAT TICKETS YOUR ARE ORDERING - DERBY & 50/50 TICKET(S) OR

                     JUST DERBY TICKET(S) OR JUST 50/50 TICKETS 

MESSAGE:  (THIS BOX WILL EXPAND TO PROVIDE SUFFICIENT SPACE FOR LARGE ORDERS)

                              ENTER THE NAME, MAILING ADDRESS, PHONE NUMBER FOR EACH DERBY TICKET     

                      BEING PURCHASED

                     IF ORDERING 50/50 TICKETS INDICATE HOW MANY TICKETS WANTED

                     (SOLD 5 for $20.00)

​PRESS SUBMIT

​

AN ORDER NUMBER WILL BE SENT TO THE EMAIL PROVIDED.  DO NOT INITIATE AN                       E-TRANSFER UNTIL YOU RECEIVE YOUR ORDER NUMBER.  DETAILED INFORMATION WILL BE PROVIDED WITH THE PAYMENT PROCESS.  THANK YOU!

Lynn Agnew, President 

John Cull, President-Elect

Randi Keith, Treasurer

Miriam Hunt, Secretary 

Email:  cobdencivitanclub@gmail.com

Mailing address:  

P.O. Box 148, Cobden, ON   K0J 1K0