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PACKAGES WORK SHEET
Please
fill out this form and provide full names, addresses and phone numbers of guest on the reverse side.
Make
checks payable to Armstrong County Friends of NRA
Return
this form to:
Dave
Zablocki, Ticket Chairman
RD #3 Box 160
Kittanning, PA 16201
Package
#1 @ $35 ( )
______________
Package
#2 @ $250 ( )
_____________
Package
#3 @ $300 ( )
_____________
Package
#4 @ $50 ( )
______________
Package
#5 @ $400 ( )
_____________
Package
#6 Amount of money you wish to spend $________________
Package
#7 Amount of money you wish to donate $________________
Package
#8 @ $25 (
) (Please include Business Card) $_______________
I’m
sorry I can’t attend, but please accept my donation of $_____________
Total Purchase: $________________
Complete
all sections that apply:
Name
____________________________________________
Address
____________________________________________
City
__________________________________ State___________
Zip _________
Telephone
_________________________________________
If
Package #3 is purchased, please complete:
Business
Name ____________________________________________
Business
Address ____________________________________________
City
__________________________________ State___________
Zip _________
Telephone
_________________________________________
Please
charge my credit card:
______
Visa _____MasterCard _____Discover
____American Express
Credit
Card # ___________________________________
Expiration
date (Month & year) ________________________________
Signature
_________________________________
Any
questions? Call or e-mail Dave or Hilma
Dave
724-543-7018 jeepjam@alltel.net
Hilma
Wingard 724-543-6029/ hilmawingard@hotmail.com
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