W I L L R O G E R S M E D A L L I O N A W A R D
®
2025 Will Rogers Medallion Award Banquet Ticket Order Form
Stay tuned for more details!
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Name: ________________________________________________________
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Email: _________________________________________________________
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I would like to order _______ Award Show Banquet tickets at $ each
________ x $ = ________ Total
I would like to pay by:
Check (enclosed)______
Money Order (enclosed)______
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My name tag(s) should read: __________________________________________, ______________________________ _____________________________, _____________________________________
Mail To: Laurie Cockerell
5313 Santa Marie Ave.
Fort Worth, Texas 76114
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Due Date & Refund Policy:
Reservations due by October 1, 2025, and are non-refundable if cancelled within one week of the banquet. In the (we believe) unlikely event we are forced to cancel the Award Banquet, we will refund your reservation.