2022 Will Rogers Medallion Award Banquet Ticket Order Form


Name: ________________________________________________________                                                                    

Address:  ______________________________________________________

Email: _________________________________________________________

I would like to order _______  Award Show Banquet tickets at $70 each


  ________  x  $70 = ________ Total


I would like to pay by:    

Check  (enclosed)______

Money Order (enclosed)______

My name tag(s) should read: __________________________________________,    ______________________________   _____________________________,  _____________________________________


                                            Mail To:   Laurie Cockerell

5313 Santa Marie Ave.

Fort Worth, Texas 76114


Due Date & Refund Policy:

Reservations are due by October 10, 2022. In the (we believe) unlikely event we are forced to cancel the Award Banquet, we will refund your reservation at the last possible moment.