3. RUMBLE OVER BAXTER'S - JUNE 13TH & 14TH
DEADLINE FOR ENTRY IS THURSDAY, JUNE 11TH
  * Required Fields
CAPTAIN'S NAME: *
YOUR NAME(if not Capt):
TEAM NAME: *
ADDRESS: *
CITY: *
STATE: *
ZIPCODE: *
WORK PHONE:
HOME PHONE:
EMAIL: *
   
SELECT A DIVISION:
DIVISION NAME: Coed Quads Lottery Draw
DIVISION CODE: QUADS
DAY: Saturday, June 13th
   
OPTIONS: Coed Quads (Partners) Lottery ($70.00)
TOTAL: $70.00
   
PAYMENT TYPE: Credit Card 
PAYMENT INFO:
Name On Card:
Credit Card Number:
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Expiration Date:
CVV Code:


Captcha: Select 1st, 2nd, 3rd, Checkbox.
You will receive an email confirmation. Please check the email receipt to confirm that you entered the correct event and/or division.