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Team
Name: |
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Phone
No.: |
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Team
Rep.:
Fax No.: |
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Address:
E-Mail: |
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City,
State/Prov. Zip/Postal Code |
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Player Name |
Fee |
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Player Name |
Fee |
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1 |
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$100 |
10 |
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$300 |
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2 |
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$100 |
11 |
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$300 |
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3 |
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$100 |
12 |
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$300 |
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4 |
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$300 |
13 |
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$300 |
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5 |
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$300 |
14 |
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$300 |
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6 |
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$300 |
15 |
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$300 |
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7 |
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$300 |
16 |
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$300 |
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8 |
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$300 |
17 |
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$300 |
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9 |
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$300 |
18 |
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$300 |
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Total |
$ |
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Payment Options - Credit Card or Check |
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Visa or MasterCard Only |
By Check or Money Order |
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Name on
card___________________________________ |
Make
check payable to ISC. Mail check and |
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forms
to: Ken Hackmeister
- 153 E. 200 S. #10 |
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Card
Number____________________________________ |
Farmington,
UT 84025. |
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Expiration
Date__________________________________ |
POSTMARK NO LATER THAN MAY 1 |
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3-digit
code on back of card near signature____________ |
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ZIP/Postal
Code of card billing address_______________ |
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House
number of card billing address________________ |
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Signature_______________________________________ |
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