RWANDA ROCKS 2017 Secure Payment Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Tables$15,000 Umuduli Lounge Seating - seating for 8 plus 2 bottles of champagne and vodka$10,000 Djembe Designated Table - seating for 6 plus 1 bottle of champagne and vodka$5,000 Conga Cocktail Table - seating for 4 plus 1 bottle of champagne$2,500 Timpani Two Top - seating for 2 plus 1 bottle of champagne$1,500 VIP Pool Cabana Lounge Seating - Includes private cocktail service (seating is limited to 12, tickets sold individually) Price: $1,500.00 Quantity: $500 Ticket - Each ticket sponsors a child for one year to attend the Rwanda Rocks Music School in Kiziba Refugee Camp Price: $500.00 Quantity: Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name