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            Email this form to Trudy (tpeischl@fairpoint.net) by June 22, 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    Pay using PayPal (you do not have to have a PayPal account)
                                PayPal Registration 
                                After making payment through PayPal, please email this Registration Form to
                                Trudy Peischl at  tpeischl@fairpoint.net and indicate that you have paid
                                the registration fee.