Beruflich Dokumente
Kultur Dokumente
Onl Onl
y$ y$
per 20 per 20
pers pers
on! on!
FireKeepers — Tuesday, May 9, 2017 (Please print neatly.) FireKeepers — Tuesday, May 9, 2017 (Please print neatly.)
Member’s Legal Name:___________________________________________________ Member’s Legal Name:___________________________________________________
Birth Date:_____/_____/________ Employer & Unit #:_________________________ Birth Date:_____/_____/________ Employer & Unit #:_________________________
Phone: (_______)______________________________ q Cell q Home Phone: (_______)______________________________ q Cell q Home
Email:________________________________________________________________ Email:________________________________________________________________
Home Address:_________________________________________________________ Home Address:_________________________________________________________
City:_________________________________ State:__________ Zip:_____________ City:_________________________________ State:__________ Zip:_____________
Guest’s Legal Name:_____________________________________________________ Guest’s Legal Name:_____________________________________________________
Guest’s Birth Date:_____/______/________ Is your guest a coworker? q Yes q No Guest’s Birth Date:_____/______/________ Is your guest a coworker? q Yes q No
If yes, list their Employer & Unit #:__________________________________________ If yes, list their Employer & Unit #:__________________________________________
Reserve a spot for (check one): q Me ($20) -OR- q Me and a Guest ($40) Reserve a spot for (check one): q Me ($20) -OR- q Me and a Guest ($40)
I/We will ride the bus from: ___ Saginaw ___ Swartz Creek ___ Lansing I/We will ride the bus from: ___ Saginaw ___ Swartz Creek ___ Lansing
___ Northville ___ Madison Heights ___Ann Arbor ___ Jackson ___ Northville ___ Madison Heights ___Ann Arbor ___ Jackson