Hosted by Vermont Adaptive Ski and Sports

Vermont 100 Endurance Race July 21-22, 2012 benefitting Vermont Adaptive Ski and Sports

DINNER AND BRUNCH EXTRA TICKETS

EXTRA DINNER TICKETS FOR Friday, July 20th	$18.00 X  #_________	$__________
EXTRA BRUNCH TICKETS FOR Sunday, July 22nd	$20.00 X  #_________	$_________
TOTAL AMOUNT ENCLOSED		$_________

(MAKE CHECK OUT TO Vermont 100 Endurance Race
CHECKS MUST BE RECEIVED BY July 2nd, 2012.

Please mail form and check to

RUNNER'S NAME (PLEASE PRINT) _____________________________________________

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