Sponsored by ZOR SHRINERS

  • print and fill out form - (prices include tax)
  • mail form to: Shrine Ciricus Fund, P O Box 44758, Madison, WI 53744
  • once we receive form, tickets will be mailed back, (pending time restraints)

Name:_________________________________________
Address:_______________________________________
City:_____________________________  St:____  Zip:_____________
 
Day phone: ___________________ other phone:___________________
Notes:_____________________________________________________