ENTRY FORM FOR NWPA MINI BIRTHDAY BASH LIVE SHOW By sending this form in- you agree that the show holders, property owners ,OR the Adelphic hall will NOT be responsible for any accidents or mishaps of any kind.
SEPTEMBER 26ST 2009
Adelphic hall- Jamestown, PA 16134
ENTRY DEADLINE IS SEPT. 15TH 2009
NAME:_________________________________________________________________
Address: _______________________________________________________________
City:_______________________________________ State:_______
Zip:_____________
Telephone number: ___________________E-mail address: _______________________
Sign here-
_________________________________________________________
Please send results: YES NO
An SASE NEEDS TO BE PROVIDED at the show for Snail Mail.
EMAIL RESULTS- YES NO
Please note: Only 1st and 2nds will be recorded.
Entry -$30.00
Please print this form and send along with payment.
EMAIL [email protected]
Please make check or money order payable to:
Karen Dietrich
4857 snake road
Jamestown, PA 16134
Pay pal, checks, and money orders accepted as payment.
