Bluegrass Nights Christmas Party

Kempton Rod & Gun Club
Kempton Pa.
610-760-1085
December 18th 2010, Doors Open - 3:00pm
$20.00 per person dinner is at 5:00pm

Name________________________________________________________________________________

Address______________________________________________________________________________

City______________________________  State_____   Zip___________Email: _____________________

# tickets________ X $20.00 = _________________  Total Enclosed

Send this form, a self addressed stamped envelope and your check to: Lynn Peters 4063 Mt View Dr., Walnutport, PA  18088

Tickets are limited to the first 180 people.