10th Annual
Brainerd Jaycees
$100,000 Ice Fishing Extravaganza
Saturday, January 22, 2000
Registration Form
| Name | ___________________________________________________ | ||||
| Address | ___________________________________________________ | ||||
| City | _______________________ | State | ________ | ZIP | _______ |
| Phone | _______________________ | ||||
| Quanity | Amount | ||||||||
| _________ | Tickets at $30 each. (postmarked prior to January 1, 2000) |
$_________ | |||||||
| _________ | Tickets at $35 each. (postmarked after January 1, 2000) |
$_________ | |||||||
| Check or money order enclosed (please make payable to the Brainerd Jaycees) |
$_________ | ||||||||
| Please bill my credit card (Master Card, Visa, Discover) | |||||||||
| Card# | ______ | - | _______ | - | _______ | - | _______ | Exp. Date ________ | |
| Signature _________________________________________ | |||||||||
| Mail To: | Brainerd Jaycees P.O. Box 523 Brainerd, MN 56401 |
Questions, call 1-800-950-9461