Registration

Name__________________________________________________________

Phone #______________________________ E-Mail Address_________________

# of Adults__________   shirt sizes_______________ (S, M, L, XL XXL)

# of children__________  

(Children do not have to pay registration, but It will be helpful to have a head count)

If you would like your child/children to have a shirt, there will be an additional cost of $5.00 per shirt.  If so, please provide the info below

# of child shirts___________  sizes___________________________

                                        Youth sizes:  small(6-8)  medium (10-12) and  large (14-16)

Please print this form and send it with your check, made out to  

                                                     Lorraine Zacierka
                                                    P.O. Box 621
                                                    Maple Shade, NJ 08052

 $40 per adult   $5. for each child's shirt   BEFORE SEPTEMBER 24th 2010.