Entry #

1. Entry # DBLS: _____________ SUPER: ___________ HIGHGM: __________ SWEEP: ___________ 8OR9: _____________ ENTER DATES & TIMES ___ VISA ____ MASTERCARD Cardholder’s Name: ______________________________ Card # _________________________________________ Signature: ______________________________________ 3% Fee on all Credit Card Sales Exp Date: ___________ ENTER Reservation Number • DOUBLES EVENT • Date Time • __________ __________ • __________ __________ • __________ __________ When entering dates and time you would like to bowl please remember tournament is limited on lanes. We will fill all requests in order of choice on a first come first serve basis. Squad # Over/Short Request our team to be paired with (see RULE 14) IMPORTANT NOTICE Obtain you local association Secretary’s verification if you are using an average from 2008-2009 season of 21 games or more I hereby certify that averages for all bowlers listed are correct and authentic according to my records _______________________________ ________________________________________ League Name Secretary Signature _______________________________ ________________________________________ League Name Secretary Signature PLEASE COMPLETE BACK OF APPLICATION IRS REGULATIONS REQUIRE US TO REPORT ALL INDIVIDUALS WHO RECEIVE $600.00 OR MORE IN PRIZE MONEY. FAILURE TO GIVE US YOUR SOCIAL CESURITY NUMBER WILL RESULT IN THE HOLDBAC OF ALL PRIZE CHECKS FOR THAT ENTRY AS WELL AS TAXES BEING DEDUCTED

2. BOWLERS INFORMATION REMIT TOTAL FEES BY MONEY ORDER, CREDIT CARD or CHECK MADE PAYABLE TO MOUTAINHOME BOWLING CENTER There will be a $30.00 charge for any returned check Entry fee payable to: Mountainhome Bowling Center. Address all communications to Mountainhome Bowling Center c/o Holiday Mixed Up Tournament, 2388 Golf Drive, Cresco, PA 18326 Phone: (570) 595-2518, Fax: (570) 595-2145, or e-mail: donna@mountainhomebowl.com or tourndirector@mountainhomebowl.com Please be sure to complete the above before submitting entry