Please print this form, fill it out, and then mail it to address below!

Date:  April 9th, 2011

Team Name (1st Side):

Division Entered:

Men's Club:

Men's Collegiate:

Women's Club:

Jersey Colors:

Team Name (2nd Side):

Division Entered:

Men's Club:

Men's Collegiate:

Women's Club:

Jersey Colors:

Tent & Water Package (1 canopy tent & 3 cases of water) = $ 100.00:

Yes:

No:

Contact Name:

Address:

Phone:

(H)

(W)

E-mail:

Entry Fee:

______  $ 275.00 per 1st Side

     ______  $ 200.00 per 1st Side before the 15th of February, 2011

          ______  $ 100.00 per Additional Side

  Total enclosed:  ____________ 

     Entry Fee Deadline:  March 12th, 2011 - Early bird deadline is the 15th of February, 2011

Make Check Payable to:

  Dan Baque

     NO CASH WILL BE ACCEPTED!!  |  Checks made out to SIU Rugby will NOT be honored!!

21st Annual All Fools Classic

c/o Dan Baque, 207 N. Oak St., De Soto, IL 62924

Check #:

Date:

Amount:

Authorized by:

Questions:

  Contact Dan Baque, 618-697-2437, or Dan Unes, 309-657-1407

If you need a receipt, other than your cancelled check, make copy of the filled out form and use it as your receipt!