2012 American Showcase Reservation Form
Name: *

First
Last
Tax ID:
Address: *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Home Phone Number: *

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Cell Phone Number:

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Email: *
Confirm *

Partner's Name:

First
Last
Tax ID:
Address:

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Home Phone Number:

### 		-
### 		-
####
Cell Phone Number:

### 		-
### 		-
####
Email:
Confirm

TO VIEW RACE DATA on the website your USER NAME will be your EMAIL ADDRESS to login. Please choose a password.
Perch fees and 1 Paid Entry of $500.00 for primary bird due upon arrival of birds.

Password: *

If your in a partnership, please provide us with a Team Name and a Team Captain

Team/Loft Name:
Team Captain:

Perch Fees:

Perch fees and 1 Paid Entry of $500.00 for primary bird due upon arrival of birds.
Number of Birds Entered: *
 One 
 Two 
 Three 

Teams Entered:

Number of Teams Entered: *
 One 
 Two 
 Three 
 Four