Northcentral Maltese Rescue, Inc. Picnic Registration Form
PICNIC DATE            Saturday, June 23, 2018
PICNIC LOCATION     Racine, Wisconsin
COST                      $25.00 per person for adults and $20.00 per person for children under the age of 16.
EVENTS                   Auction, guest speakers, obedience demonstration, pet 
                             photographer, dog painting.

REGISTRATION         Use this Form or Click on the PayPal Registration site below 
                             Print this Form for a black and white printer friendly copy

PLEASE NOTE            Trudy must receive this form no later than June 18, 2018


DONATIONS             Please add a donation to help with veterinary expenses  

PLEASE PRINT
NAMES OF EVERYONE ATTENDING _________________________________________________________________________

___________________________________________________________________________________________________________

NOTE THE NAMES OF CANINE GUESTS AND INDICATE THE BREED (maximum 20 pounds)
______________________________________________________________________________

YOUR ADDRESS (city, state and zip code) 
______________________________________________________________________________
______________________________________________________________________________

YOUR PHONE NUMBER  ______________________________________________________________________________

YOUR EMAIL ADDRESS  _______________________________________________________________________________

PAYMENT    Please reserve space for _______ adults at $25.00 each and _______ children at $20.00 each.
                  In addition to my registration, I would like to make a tax-deductible contribution to the Rescue of
                  $__________
                  The total for my registration and donation is: $___________

PAYMENT METHOD   Payment Option 1:  I am enclosing a check payable to Northcentral Maltese Rescue, Inc.  
                                                          Send check with a printout of this Registration Form to:
                                                              Trudy Peischl
                                                              110 Scenic Lane
                                                              Ellensburg, WA  98926

                            Payment Option 2:  I am paying through PayPal. To pay by PayPal, follow this link: 
                                                           PayPal Registration 
                                                           After making payment through PayPal, please email the Registration Form 
                                                           to 
                                                           Trudy Peischl at  tpeischl@fairpoint.net and indicate that you have made 
                                                           payment