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Registration Form |
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Annual "MIKE'S EASTER ON THE FARM" |
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Saturday, April 3rd, 2010 |
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(Hunt held rain or shine!) |
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Admission price is $8.00 per person (child or adult). "NON-REFUNDABLE" |
| Deadline for entries is Monday, March 29th, 2010 |
NAME: _________________________________________
ADDRESS: ______________________________________
PHONE NUMBER: _______________________________
EMAIL ADDRESS: _______________________________
# OF CHILDREN: 1-4 YEARS:__________
5-7 YEARS:___________
8-ABOVE:___________
TOTAL # OF ADULTS:__________________
TOTAL ENCLOSED: $ __________________
Please circle your preferred hunt time (hunt time is first come, first served basis):
| 10:00am | 11:00am | 12:00pm | 1:00pm | 2:00pm | 3:00pm |
Mastercard or Visa (circle one) Number: ______________________________ Expiration Date (month) ____ Year:______
Employee's Initials:_________________
Print, return form & payment to:
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MIKE'S FARM & COUNTRY STORE |
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| 1600 HAW BRANCH ROAD | ||
| BEULAVILLE, N.C. 28518 | ||
(910) 324-3422 |