REGISTER YOUNG'S JERSEY DAIRY
print the page and mail check to:
Mike Peirano
2921 Archer Dr
Springfield, Oh 45503
Registration Info
Pre-registration will be open from 19 Jul 2007 until Jul 10 2008.
AFTER JUL 10 REG AT THE CAR SHOW
WE STOP ORDERED FOR T-SHIRT 1 Jul 08.
Registrations Fee: $20.00
First Name: ____________________________
Last Name: _____________________________________________
Email Address: ___________________________________________
Address: ___________________________________________
___________________________________________
___________________________________________
City: ____________________________________________ State: ___________________
Zip: _________
Country: ____________________
Evening Phone: ____________________________________
Day Phone: _________________________________________
Year PT Cruiser: __________ Color: ___________________
Year HHR: __________ Color: ___________________
Registration Fee: $20.00
# Attending: ____________
Additional Attendees: _________________________________
YOU CLUB: __________________________________________________________
T-shirt: S/M/L/XL $10.00 - 2X $12.00 - 3X $13.00
T-shirt S Number:
M Number:
L Number:
XL Number:
2X Number:
3X Number:
GOLF SHIRT S/M/L/XL $13.00 - 2X $15.00 3X $16.00
T-shirt S Number:
M Number:
L Number:
XL Number:
2X Number:
3X Number:
DAIRY COW SHIRT S/M/L/XL $12.00 - 2X $14.00 - 3X $16.00
T-shirt S Number:
M Number:
L Number:
XL Number:
2X Number:
3X Number:
THE WILDS S/M/L/XL $12.00 - 2X $14.00 - 3X $16.00
T-shirt S Number:
M Number:
L Number:
XL Number:
2X Number:
3X Number:
Registrations Fee: $20.00
Dinner Saturday $13.00 each: + $__________
T-shirt: + $___________
GOLF shirt: + $___________
DAIRY COW shirt: + $___________
HAT: + $___________
Mover and Shake Train ride: $2.00 ea person
Mover and Shake: + $ ___________
Total costs: $ ___________
Reg for Sunday 20, 2008 "The Wilds": Yes:________ No:________
We have a Dash Plaque for "The Wilds"
Phone - 937-399-2479
Cell - 937-360-1551