DYERSVILLE DRIFTSKIPPERS

PRINT THEN FILL OUT AND SEND TO THE ADDRESS BELOW.

 

FIRST NAME: _______________________________________________________________________

LAST NAME: ________________________________________________________________________

ADDDRESS: _________________________________________________________________________

CELL PHONE NUMBER:  ________________________________

Would you like meeting reminders?            Y / N          via text    or     e-mail        circle one   

E-MAIL: ____________________________________________________                                                                                                                      

DATE OF BIRTH: ___________________________

NUMBER OF SLEDS REGISTERING: ________

$35 FOR FIRST SLED $5 FOR EACH ADDITIONAL SLED (INCLUDES MEMBERSHIP TO ISSA)

                                                                           TOTAL $              

SIGNATURE: ________________________________

SEND TO:   DYERSVILLE DRIFT SKIPPERS PO. BOX #143 DYERSVILLE, IA, 52040.