MN USA ANNUAL AWARDS BANQUET SUNDAY October 5th, 2014 1
MN USA ANNUAL AWARDS BANQUET SUNDAY October 5th, 2014 1:30 p.m. Neighborhood House 179 Robie St E St Paul, MN 55107 (612) 789-2542 http://www.neighb.org/ Come join us as we celebrate the successes of our wrestlers, clubs and volunteers!
Pre-registration Ages 5+ $15.00 Under age 5: $8.00 At the door: all meals $20.00 Complete registration form below and return with check or money order by Sept 27th for Pre-registered price. If you have any questions contact Donita Flodeen at 507-263-3964 or 507-319-0379
MN USA ANNUAL AWARDS BANQUET SUNDAY October 5th, 2014 1:30 p.m. Pre-Registration Form Name:
Club :
# Attending: Ages 5 and over:
($15.00 each)
Under age 5:
($8.00 each)
Total: $ Please submit form and check or money order or credit card information to MN USA Wrestling P.O. Box 231 Cannon Falls, MN 55009 Credit Card Information: Please PRINT clearly Name as it appears on Credit Card Billing Address: (Street, city, state, zip – need entire billing address) Telephone Number: Visa or MasterCard (Circle One) Credit Card Number: Expiration Date:
3 digit security code: ___
I authorize to charge the amount indicated in the Total field identified above to the card number listed. I verify I am authorized to charge on this account. (Signature)
(Date)
(Print Name) **Must be postmarked by Sept 27th for Pre-registered price, cost at the door is $20.00 per person
Pre-registration Ages 5+ $15.00 Under age 5: $8.00 At the door: all meals $20.00 Complete registration form below and return with check or money order by Sept 27th for Pre-registered price. If you have any questions contact Donita Flodeen at 507-263-3964 or 507-319-0379
MN USA ANNUAL AWARDS BANQUET SUNDAY October 5th, 2014 1:30 p.m. Pre-Registration Form Name:
Club :
# Attending: Ages 5 and over:
($15.00 each)
Under age 5:
($8.00 each)
Total: $ Please submit form and check or money order or credit card information to MN USA Wrestling P.O. Box 231 Cannon Falls, MN 55009 Credit Card Information: Please PRINT clearly Name as it appears on Credit Card Billing Address: (Street, city, state, zip – need entire billing address) Telephone Number: Visa or MasterCard (Circle One) Credit Card Number: Expiration Date:
3 digit security code: ___
I authorize to charge the amount indicated in the Total field identified above to the card number listed. I verify I am authorized to charge on this account. (Signature)
(Date)
(Print Name) **Must be postmarked by Sept 27th for Pre-registered price, cost at the door is $20.00 per person
