\; \; \; \; \; \; \;&ldquo\;Walk On The Wild Side!&rdquo\;

10^th Annual

Independence Village

(formerly HRA Village)

Dinner &\; Dance

Nessler Center &ndash\; Texas City\, Texas

Emcee &ndash\; Mr. Pete Rygaard
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Silent Auction
Bidding will close at 9:30 PM\, so get ready to bid! \;Items include original artwork\, jewelry\, dining packages\, sports memorabilia and much more!
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Check our website:
www.independence-village.org

The proceeds from this event will be used for The Independence Village (formerly HRA Village)\, an assisted living facility for residents with developmental and physical disabilities

TICKET ORDER FORM
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Name ___________________________
Company_________________________
Address_________________________
City ____________State___ Zip______
Phone ___________________________
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Couple Sponsor \; \; \; \; \; \; \; \; \;$175.00
(Two (2) tickets to Gala\, and names in program)
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Individual Sponsor \; \; \; \;$100.00
(One (1) ticket to Gala\, and name in program)
Individual Ticket \; \; \; \; \; \; \; \; \; $35.00
**Value of each individual ticket is $35.00**
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Please indicate quantity and level of tickets requested (as noted above):
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Level: ___________________________
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No. of tickets ______ @ $________each
Total enclosed $__________(Check)
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Please bill my ___Visa or ___MasterCard
Account # ________________________
Expiration Date ____________________
Signature: ________________________
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We are unable to attend\, but would like to contribute\, $__________.
Please bill my credit card as noted above.
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Please make checks payable and mail to:
The Independence Village
905 Highway 3 North
Texas City\, TX \;77591
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