United Bowhunters Of Pennsylvania
			581 Madison Shop Road
			Rimersburg, PA 16248 


	Print this form out and fill it in with your order and send via US Postal Service 
			Use your credit card for faster service

	Circle One: 	Check/Money Order Enclosed
			
			Visa	Mastercard	American Express

			Account # _________________________________

			Expiration Date ___________________________

			Name ______________________________________

			Street Address ____________________________

			City ______________________________________

			State ______________ Zip __________________

			Phone # _____ _____________ ( include area code )

			Email address _____________________________

		Rendezvous MEALS:
		Qty	Meal	Price

		_____	Saturday Lunch $20 (adult) 			$ _______
                
                _____	Saturday Lunch $15 (youth 16 & under) 		$ _______

		_____	Saturday Dinner $35 (single)			$ _______

		_____	Saturday Dinner $60 (couple)			$ _______
		
		_____	Saturday Dinner $20 (youth 16 & under) 		$ _______

		_____	Life Member Breakfast: $15 (single),$15 (guest)	$ _______

    	                                 	Total Enclosed: 	$ _______
				
				


	Signature _______________________________________________________