ADDRESS:__________________________

 

CITY:______________________________

 

STATE:______________ZIP:___________

 

E-MAIL ADDRESS:__________________________

 

PHONE NUMBER:____________________

 

PASSENGER'S NAME:_________________

 

T-SHIRT QTY:_________   

 

SIZE:_______ :_______:

 

AMOUNT ENCLOSED:$_______________

 

PRICES:

SINGLE RIDER:             $45.00

TWO UP BIKE:               $80.00

ADDITIONAL SHIRTS:   $15.00

 

PLEASE MAIL TO:

                          2006 MIDWEST STAR-B-Q

                          C/O L.WETLEY JR.

                          610 N BIRD ST

                          SUN PRAIRIE WI 53590