La Grange Picnic Form

September 7, 2008 Picnic SignUp Form

Please submit this form by September 2
even if you are not bringing Family or Guests.
We need a headcount.

Be sure to fill in all boxes.

Full Name:

Phone:

Email:

Number of La Grange Members:
members (no charge)

Number of family Members @ $10 ea:
family members

Number of guests @ $15 ea:
guests

Total Amount:
Amount (dollars) due

PAYMENT INFORMATION

$10.00 for each family member

$15.00 for each guest

MAIL A CHECK

PAYPAL

If you are bringing Family or Guests, please mail a check, payable to Velo Club La Grange, to

Velo Club La Grange
La Grange Picnic
c/o Claude Innocenti
11817 Texas Avenue, #5
Los Angeles, CA 90025

click here

Don't have a PayPal account?
Use your credit card or bank account.

From the www.paypal.com website, send payments to cfo@lagrange.org.

back to La Grange PICNIC

Number of La Grange Members:	members (no charge)
Number of family Members @ $10 ea:	family members
Number of guests @ $15 ea:	guests
Total Amount:	Amount (dollars) due