Please be advised although we try to check the e-mails every day
sometimes we cannot respond immediatly
if you need information quickly please call us first.
This form sends an e-mail to Wes, Tyler & Tara as part of your
PRE-Registration
FOR THE
Civic Holiday WEEKEND
Annual LADIES WEEKEND BREAST CANCER FUNDRAISER!
- July 30th-August 2nd, 2010 -
at King Hamilton Farms by Duttona Beach
When your registration has been verified you will be sent via E-mail an Invoice to pay your donation via Paypal
Be sure to double check that all the Registration Information is correct, you will be required to
bring a printout of your Paid Paypal Invoice along with Gov issued photo ID on arrival for the weekend.
First name:
Last name:
Address Line 1
Address Line 2
City -
Prov -
Postal Code -
How did you hear about us?
Birthdate: (dd/mm/yyyy)
Primary Phone:
Email:
*
Emergency Contact - Name -
Relationship to Emergency Contact -
Emergency Contact - Phone -
Comment:
* NOTE - Your Paypal Invoice will be sent to this e-mail address be sure it is correct