Event Name:
Pre-Registration Form
Name
Award & Credit
$7.00
$7.00
Credit Only
$3.00
$3.00
Non IVV
$2.00
$2.00
Total
Amount
Amount
Total $ >>
Address
City, State, Zip
Make checks payable to Penn Dutch Pacers
Mail pre-registration to PENN DUTCH PACERS, Walk Pre-registration
PO Box 7445, Lancaster PA 17604-7445
To guarantee pre-registration this document along with payment must be in the hands of the registrar 10 days prior to the event.
Date
Check #
Total Amount
[ ] check for
PDP
Membership
Info
PDP
Membership
Info