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Welcome to the City of Roxboro, NC, Action Line

Today is Saturday, November 21, 2009.

MAYO PARK HORSESHOE TOURNAMENT ENTRY FORM

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2009 Mayo Park Fall Festival

Horseshoe Tournament Entry Form

Saturday October 10, 2009

Mayo Park Roxboro, NC

* Information is required.

Contact Information

* First Name:
* Last Name:
Business Name:
Email:
* Daytime Phone:	() –
Fax:	() –
* Address:
* City:
* State:
* ZIP:

* Age on October 10, 2009

* Date of Birth

Home Telephone

Male

Female

* T Shirt Size

Small

Medium

Large

Extra Large

XXL

* Emergency Contact Information: Name

* Relationship

* Telephone Number for Emergency Contact

* Registration Fee - Additional $3.00 conveniience fee for credit card payments - Mastercard or VISA only

* Raffle Tickets $500 Gift Certificate Dicks Sporting Good Tickets are $1 each or Book of 6 for $5 Raffle tickets may be purchased at the event.

* Optional Lunch Tickets for Participants, Family & Friends. Not included in registration fee.

* Total (Make Checks Payable to Person County - Mayo Park)

Credit Card Information

Credit Card Number

Expiration Date Month

Expiration Date Year

CVS Number (3 or 4 Digit Number on Back of Credit Card)

Total Amount Charged to Credit Card

Check here to have email confirmation of this request sent.

* Information is required.

Mail Completed Form To:

Mayo Park Horseshoe Tournament

Person County Recreation Arts & Parks Department

425 Long Avenue

Roxboro, NC 27573

Contact Information:

John Hill

Telephone: (336) 597-7806 Mayo Park

Telephone: (336) 597-1755 Office

E-mail: johnhill@personcounty.net

Visit our websites at:

http://mayo.personcounty.net or http://recreation.personcounty.net

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