PRINT, FILL OUT AND MAIL TO THE BELOW ADDRESS.

Dinner Adult #____ @ $30.00

Dinner Youth (18 or younger) #____ @ $20.00

Membership #____ @ $35.00

I cannot attend, however, enclosed is my tax deductible donation to NOCOPF: $________

___ Yes, contact me about helping on a committee:

         Name: _________________________ Phone: _________________

Email address: ____________________________________________________________________

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Raffle Tickets #_________ @ $10.00 each.

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Payment Method
 
___ Check enclosed (make payable to NOCOPF)
 
Credit Card:     _____ MasterCard          _____ VISA          _____ American Express
 
Name on card (print, please): ____________________________________

Card #: ______________________________________________                                         

Expiration: ___________________________________________

CVV Code: ________
The CVV is the 3-digit code after the credit card #,
in the signature area on back of the card

 
Signature: ____________________________________________
         	(your signature is required)

Your PF membership #: ________________________

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Please pick up your tickets at the banquet check-in table

Mail to: NOCOPF (JB Barthlama)
		 1619 Waterford Lane
		 Fort Collins, CO 80525