Print This page and fill out /send in with paid Registration

 

REGISTRATION ---------------------------------Pre- Registration Saves $12.00

Full Package By December 31st -----------$30.00 x _________ Total___________

(Includes Registration: Friday Dinner /karaoke: Saturday Lunch: Dinner: Dance

INDIVIDUAL:

Registration Only ________X $10.= ____________

Friday Dinner ***________X $7.= ____________

Saturday Lunch *_________X$5.= ____________

Saturday Dinner _________ X$12.= ___________

Saturday Dance _________ X$5.= _____________

T-shirts (sm./med./lrg ***** ________X$12.= ____________

(xl/xxl/xxxl) *************________X$13.= ____________

Coffee Cups ************_________X$5.= ______________

 

Name____________________________________ Name__________________________________

Address__________________________________________________________________

city_____________ST._______________Zip.__________

 

Checks payable to the Mesa Roundup

P.O. Box 814 , Mesa AZ 85201

Registration Contact