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NORTHSTAR LANES 400 Prosser Place Antigo, WI
***DETACH BOTTOM PORTION and RETURN to***
***Secretary/ Treasurer, Jennie Volkman *** jenniev24@hotmail.com WI State 600 Bowling Club W10095 Mary Ln Antigo, WI 54409 Phone: 715-350-1637
E-Mail: wistate600club@gmail.com WI Club Website – www.wisconsin600club.org Facebook
NAME: ____________________________________________________________________ Year of Birth ____________
ADDRESS: ________________________________________________________ Nat’l 600# _________________ USBC # _____________________
_________________________________________________________ Highest Ave _________ Assoc ___________________________
EMAIL ADDRESS: _____________________________________________________________PHONE #____________________________________
Hdcp Events Entering: Singles $20.00 _____ Doubles $20.00______ All Events $5.00 _____ Scratch Events: Singles $10.00_____ Doubles $10.00______ All Events $5.00_____ Total: $_______________
NAME: ____________________________________________________________________ Year of Birth _____________
ADDRESS: __________________________________________________________ Nat’l 600# _________________ USBC # ___________________
____________________________________________________________ Highest Ave ________ Assoc _________________________
EMAIL ADDRESS: ____________________________________________________________ PHONE #____________________________________
Hdcp Events Entering: Singles $20.00 _____ Doubles $20.00______ All Events $5.00 _____ Scratch Events: Singles $10.00_____ Doubles $10.00______ All Events $5.00_____ Total: $_______________
PREFERRED Date/Time (list three)
DATE: 1st _________________________ 2nd ____________________________ 3rd ___________________________
TIME: 1st _________________________ 2nd ____________________________ 3rd ___________________________
CONTACT PERSON: _____________________________________ Phone #____________________________
E-mail _________________________________________________
TOTAL FEES ENCLOSED $ ___________________
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