Des Moines Dance - Gift Certificate Request
 
 *Purchasing for:
 *From Name(s):
 *To Name(s):
 *Address where
   gift certificate is
   to be mailed:
      Enter Pickup if you plan to pick up at one of our classes
 *Amount Desired:  .00    Please fill in amount even if you have selected a class above
         Please include an additional $2 for shipping and handling if you would like this mailed.
*Certificate Type:  Anniversary    Birthday   Christmas   Valentines Day   Wedding   Other
 *Your E-Mail:
 *Your Phone:
Make check to: Des Moines Dance                                    To arrange an in person pick up
   and mail to PO Box 761      attn. Gift Certificate         call 515-865-6043
  Indianola, IA  50125