| Registration For... | Total |
|---|---|
| ____ Adult @ $110/ea. ($135.00/person after 3/1/08) | = ___________ |
| ____ Student (13 yrs to college)@ $95.00/ea. ($110 after 3/1/08) | = ___________ |
| ____ Children age 5-12, @ $40.00/person ($64 after 3/1/08) | = ___________ |
| ____ Children 4 and younger free (no meals) | = ___________ |
Enclose a check payable to the Texas Jack Association by May 15 for TOTAL= __________
Name: ______________________________________________________
Address: ____________________________________________________
___________________________________________________________
Phone: (_______)______________________
E-mail address (Print carefully): ___________________________________________________
*Please give first and last names of all who are coming for name tags.
_________________________________________________________________
__________________________________________________________________
_________________________________________________________________
Mail check and form by May 15, 2008, to:
Rene Tyree, Treasurer
244 NW Whitlock Dr.
Lee’s Summit, MO 64081