Name ___________________________________________________________   Age _______________________

 

Address _________________________________________________________   Zip ________________________

 

City _____________________________________________________________   State ______________________

 

Day Phone ____________________   Evening Phone ___________________   Email ______________________

                                              

                                       Send To:          Dave Sixel

                                                                203 Illinois St, Eagle River, Wi.  54521

 

p I’ll Take The Budget Plan, $ 55.00 Enclosed, $ 55.00 Due June 15th, And $ 55.00 Due on August 15th.