| Print out the form below, fill it out and sign. Send the completed form and your deposit of $100.00 per person, to secure your reservation. The Balance of $815.00 Per Person will be DUE ON July 1st, 2009. |
| MAKE CHECKS PAYABLE TO: "UNCLE OZZIE" PO Box 341, Portage, WI 53901 |
| If you have any questions about the trip, please contact us. Call (608) 742-8707. (If no answer, please leave a message.) Cell (608)-334-9332 Or E-mail us by clicking here |
| NOT RESPONSIBLE FOR: Any damages, losses, expenses or inconvenience caused by late arrivals, departures, change of schedules, injury, or damage to any person or property from any cause what so ever. |
| When the trip gets closer you will get an updated schedule and cover letter. |
| ---------------------------------------------CUT HERE & RETURN--------------------------------------------------- |
| Name(s)________________________________ |
| Address_______________________________ |
| City___________________ ZIP________ |
| Phone(____)_________________ |
| Email Address__________________________ |
| PICK UP AT: Portage South Side 6:30AM____ Madison (Park -N- Ride) 7:15AM.____ |
| Rooms |
| Non Smoking_____ Smoking_____ (1) Bed ____ (2) Beds ________ |
| Emergency Contact #_____________________ |
| BOTH Signatures Please |
| X__________________________________ X___________________________________ |
| Do you have a Birthday, Anniversary or other Special Event in the month of early Nov? Let Us know by filling in the form below, and send it in with your trip reservation. |
| NAME:_______________________________________________ TYPE OF EVENT:_____________________________________ DATE OF EVENT:_____________________________________ Name You Prefer On Your Name Tag:____________________________________________________ |
| 8 days in Memphis & Nashville, TN 2009 |
| Are you Diabetic?__________ |
| Cell Phone(___)____________________ |
| Name(s)_______________________________ |