EmailMe Form - Chili Dinner and Bingo Registration Form

Name *
First Last
Address *

Street Address City State / Province / Region Postal / Zip Code
Day Time Phone *
### - ### - ####
Email (will not be shared or published) *
Retype Your Email Address Below

Confirm Email Address
Number of Attendees (Including Yourself and Guests) *
Attendees age groups *

Over 12 years old

Under 12 years old

ACCEPTED PAYMENT IS BY CASH OR CHECK AT THE DOOR ONLY

Children under 12 years old cannot participate in Bingo Games. ($10 for dinner and beverages only)

Attendees 12 years old and over. (Cost is $20 person for 10 Bingo Games, dinner and beverages)
Comments
Should you have any questions please type them in above

Over 12 years old
Under 12 years old