PRE-SALE PAYROLL DEDUCTION FORM LMG HOLIDAY POD FAIR DECEMBER 3 RD , 2019 Today’s Date: _____________________________ Pod/Practice Name: ___________________________ Employee Name:_____________________________________ Payment Method: Payroll Deduction (deducted from Dec. 13 th , 2019 check) Ticket Pricing if you buy before November 22 nd : (check only one box) 5 for $25 35 for $150 15 for $50 40 for $175 ______ for $______ 20 for $75 45 for $200 25 for $100 50 for $225 30 for $125 55 for $250 Total Amount Purchased: $ ____________________ Employee Signature: _________________________ Office Manager Signature: _________________________ If you are unable to attend the event, please list the name of the person picking up your tickets: ___________________________________________ *NON-REFUNDABLE. PICK UP TICKETS AT THE WILL CALL TABLE ON DEC. 3 RD * *THIS FORM IS DUE BACK VIA EMAIL TO [email protected] NO LATER THAN NOVEMBER 21ST*