Coupon 1 (One event or trip per coupon please)
Name of Event:      Event Date:

Name:      Member Number:

Name:      Member Number:

Name:      Member Number:


Street Address:

City:     State:     Zipcode: -

Phone:

E-mail Address:

Number of Members @         $  = $

Number of Non-Members @ $  = $ (Where allowed)

No of    @      $  = $ (Children, Guests)

Total Enclosed $


Don't forget a self–addressed, stamped envelope, if you didn’t provide an e–mail address.
Mail coupon and check to the trip Contact person. Make checks payable to “PSC”.


                         

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