EmailMe Form - MSIR's Chicago Picnic

Name *

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email *

Would you like to be added to the Midwest Shiba Inu Rescue email list?

Yes

No

Picnic Information

Tickets are $15 per adult or $40 per family (2 adults and up to 3 kids under 12). Ticket includes lunch.

Number of ADULT attendees

Number of Child attendees

Name of ALL attendees in party, name tags will be provided for everyone attending. Please include first and last names for adults and first only for kids.

Attendee 1

First Last

Attendee 2

First Last

Attendee 3

First Last

Attendee 4

First Last

Attendee 5

First Last

Please provide information about each dog that will be attending the picnic.

1) Dog's Name

- Dog's Breed

- Is this dog a MSIR Alum?

Yes

No

2) Dog's Name

- Dog's Breed

- Is this dog a MSIR Alum?

Yes

No

3) Dog's Name

- Dog's Breed

- Is this dog a MSIR Alum?

Yes

No

4) Dog's Name

- Dog's Breed

- Is this dog a MSIR Alum?

Yes

No

5) Dog's Name

- Dog's Breed

- Is this dog a MSIR Alum?

Yes

No

Are you interested in donating a door prize?

Yes

No

Would you like to volunteer?

Door Prize Tickets

Tickets are available at 1 for $1, 6 for $5, 13 for $10, or 30 for $20.

How many door prize tickets would you like to purchase?

*If selected "Other," how many tickets would you like to purchase?

Any additional information or comments

Picnic Information

Door Prize Tickets

Thank you and see you in Chicago!