Regatta T-Shirt Order Form             No. _________                                                  November 5-7, 2010 
 
Name:       (Print) _________________________________________________________
Number in Party: _________________________________________________________
Home Phone Number: _________________________________________________________
Cellphone Number: _________________________________________________________
Email Address: _________________________________________________________


 
Regatta T-Shirts:
Regatta T-Shirt     S    M    L  XL XXL       
  Number wanted:___ ___ ___ ___ ___  $8.50 X         #________ Total $____________
                                         Check # __________________

Checks Due by October 8, 2010 Payable to "PGI Seafarers"
Your check is your receipt!

Do Not Combine Your Registration Check with Your T-Shirt Check!

Mail Form & Check To:
Linda Supakoff
PMB 138
1133 Bal Harbor Blvd., Suite 1139
Punta Gorda, FL  33950

No cancellations / refunds after October 20, 2010