PAYPAL EMAIL TEST PAGE RESERVATION FORM Title (required) MrMs Name (required) Last Name (required) Your Email (required) Party Size Maximum 4 Guests To Keep Quiet Policy During Performance (required) 1234 ARTIST NAME Artist Name, Date, 7pm - $1000 Dinner & Concert SHOW STARTS AT 7:00PM Seating Times 6:00 PM6:30 PM Would You Let Us Add You To Of Our Mailing List? (required) YesNo Is This Your First Visit To Bloom? (required) YesNo Please Tell Us How You Heard About Us (not required) Select From Drop-down List91.1 Jazz FMCBC RadioOnline SearchNeighborhood Word Of MouthFriend Or RelativeRegular Bloom Patron PLEASE ACCEPT OUR TERMS (Required) By checking this box You, on behalf of your party, agree to comply with our STRICT QUIET POLICY during performance. We require a Non Refundable $11.30 ($10 +HST) deposit per guest as in your reservation. Click on the PAYPAL button below to proceed.