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If you would like to order a t-shirt
for this event…..Please specify your size and number of t-shirts
on the form below. Each shirt is $18.00
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| Registration deadline is October
1st, 2009
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Name________________________________________
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| Address______________________________________
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| City_____________________State_____Zip_________
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Additional
names (for name badges) Please specify if any under 18.
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_____________________________
_____________________________
_____________________________
_____________________________
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| Phone___________________________________
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| E-mail________________________________________
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Club
affiliations (Please circle all that apply)
Badger
State Fox Valley Chicagoland
Lakeshore Other____________________
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Attending______
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Number
of
T-shirts |
Small |
Medium |
Large |
X-Large |
XX-Large |
XXX-Large |
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| .
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Total for registration (before
9-17-09) . . . . _____
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x $26/person = $
___________
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Total for registration
(9-18-09 to 10-1-09) . ._____
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x $30/person = $
___________
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Total for T-shirts . . . .
. . . . . . . . . . . . . . . . . . _____
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x $18/each =
$ ___________
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Total enclosed . . . . . . . . . . .
. . . . . . . . . . .
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.
. . . . . . = $ ____________
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Mail registration to (Make check payable
to):
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Please send this complete page.
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Randy Geipel
1225 N 123rd St.
Wauwatosa, WI 53226
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Phone: (414) 777-067
E-mail: PTCroooser@wi.rr.com
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