Make Check payable to: Jeff Erz

Mail form to:

JEFF ERZ
W11798 RAUBE RD
BRANDON WI 53919

COST per person	# of people	Total cost
Rafting Special $39
Rafting ONLY $25
Camping ONLY $16
	TOTAL
Rafting $25 — Camping $16 DEPOSIT
	BALANCE
Name:
Phone #:

NOTE: Each Camping/Rafting participant must submit name and phone number for people included on the form if not in the same household. (List below)

FVS 03-26-08