Please print this form, complete, and submit with payment to:
SBRT
59 E. Main St.
Bloomsburg, Pa. 17815
Make checks payable to SBRT
Amount: $25
Participants will be required to sign a release at event check-in.
Name:________________________________________________
Address 1:_____________________________________________
Address 2:_____________________________________________
City:__________________________________________________
State:____________________Zip:__________________________
Phone:________________________________________________
E-Mail (optional):_______________________________________
T-shirt size (circle): S M L XL