2006 FedEx Lemans Registration FormEvent Date: May 22, 2006 |
|
Print out Form
and Complete Return this form via fax or mail to:
|
Victor George
7435 N. Keystone Ave.
Indianapolis, IN 46240 Fax: 317-252-5700 |
| Contact Information: |
| Name:_______________________________________________ |
| Mailing
Address:_______________________________________ ____________________________________________________ |
| Email:_______________________________________________ |
Billing options: |
|
Bill me now for ________ (Qty) team(s) @ $2,500 each totaling $__________ Bill my Credit Card for ________ (Qty) team(s) @ $2,500 each totaling $__________ (Must be paid before the event) |
| Credit
Card Information:
Mastercard
Visa
American Express
(Please circle your credit card choice.) Credit Card Number: _______________________ Exp. Date: _________ |
| Signature ______________________________________ |
| All you have to do is sign up and commit now, we'll do the rest! Thank you for helping to make this a great event! |
| Copyright © Junior Achievement of Central Indiana Inc., 2006 |