Registration YJD 2009

REGISTER YOUNG'S JERSEY DAIRY

print the page ad mail check to:

MIKE PEIRANO

2921 ARCHER DR

SPRINGFIELD, OH 45503

Registration Info

Pre-Registration now to 30 June 2009

Pre-Registrations fee: $25.00 Goody Bags, one T-shirt

and dash plaque.

After 30 June 2009 fee: $30.00

First Name: ________________________________

Last Name: ________________________________

Email Address: _____________________________

Address: __________________________________

__________________________________

City: ______________________ State: __________

Zip: ______________________ Country: ________

Evening Phone: _____________________________

Day Phone: _____________________________

Year PT Cruiser: ____________ Color: _______________________

Attending: _______________________________________________

Your Club: ______________________________________________

Your size T-Shirt: _________________

FEE: _________________

ADDITION DAIRY COW SHIRT

S $12.00 _________________

M $12.00 _________________

L $12.00 _________________

XL $12.00 _________________

2X $14.00 _________________

3X $16.00 _________________

4X $18.00 _________________

PT CRUISER AND CHRSLYER RALLY SHIRT