.:: A SPECIAL MEMORY WEDDING CHAPEL | Make your wedding A Special Memory! ::.

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Reservations

Groom First Name:		Last Name:
Bride First Name:		Last Name:
Street Address:
City:		State: Zip Code:
Country:
Daytime Telephone Number:
Evening Telephone Number:
Fax Number:
E-mail Address:

Requested Day/Date of Ceremony:
Requested Time of Ceremony:
(All reservations made for the next 24 - 48 hours should be followed up with a phone to assure the reservation was received in time.)
Hotel in Las Vegas where you will be staying:

Wedding Package:

Other Options Desired:
Professional Organist $35
Candlelight Ceremony $38
Video Added to Package "A" $75

Flowers: If your package includes flowers, please let us know which type you prefer.

Fresh or Silk

Color:

Wedding Cake: Please select the type of wedding cake you would like.

Cake Flavor:

Cake Filling:

Cake Prices Include Delivery & Tax

Do You Want Us To Provide Limousine Pickup? Yes or No

Specify additional requests here:

All reservations must be guaranteed with a major credit card.

Payment Type: (Only these payment types are accepted)

If you do not wish to enter a credit card number online, you can print this page out, WRITE in your credit card information, sign below and FAX it to the chapel at:
702-384-2232

Or if you do not have access to a fax, just call us directly at 1-800-962-7798 to make your reservation. Please mention that you heard about us online at ASpecialMemory.com.

Card Number: Exp. Date:
Name on Credit Card:

By submitting this form I, authorize the required $100 deposit to be charged to the above credit card.
This will be deducted from your balance, which can be paid upon your arrival at the chapel.
All deposits are non refundable. No substitutions please.

Sep	OCT	Nov
	08
2005	2006	2007