Note: If you would like to use PayPal, then then please use “Get Your Ticket”, otherwise to mail your registration please print and fill out this form. Make sure you indicate your purchase request at the bottom of the page. Thank-you.

• Name – Ticket 1
  First Name
  Last Name
• Address
  Street Address
  City
  State                  Zip Code
• Email
  Email address
• Button Information
  Button – First Name
  Button – Last Name
  Club Affiliation(s)
• Name – Ticket 2
  First Name
  Last Name
• Address
  Street Address
  City
  State                  Zip Code
• Email
  Email address
• Button Information
  Button – First Name
  Button – Last Name
  Club Affiliation(s)

 

Ticket Type	Number of Tickets Requested
Weekend Pass		$90.00 each	$
Friday – Day Pass		$75.00 each	$
Saturday Day Pass		$75.00 each	$
Total			$

---

Mail the filled out registration form, your check made out to “Mid-Ohio Boogie Bash”, and a self-addressed stamped business-size envelope to:

Copyright © Mid-Ohio Boogie Club 2013