Texas Jack Association
2016 ROUNDUP REGISTRATION FORM
June 22-25, 2016
Kansas City, MO
(Roundup participants should make their own Hotel reservations by May 20, 2016)
_____Adult(s) @ $150.00/person = __________
_____Student(s) (13 yrs to college) @ $130.00/person = __________
_____Children (5 yrs to 12) @ $85.00/person = __________
_____Children (4 and under) free
Name: _____________________________________________________________________
Address: ___________________________________________________________________
___________________________________________________________________________
Home Phone: (_____) ____________________ Cell Phone: (_____) ____________________
Email address: _______________________________________________________________
* Please print first and last names of all who will be attending so name tags can be made:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
*NOTE: All attendees must be current members of the Texas Jack Association. If you are not a current member, kindly fill out the following:
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TJA MEMBERSHIP FORM
_______Individual Adult @ $25/person =___________
_______Family (all persons living at the same address) @ $40/family = ___________
_______Senior (65 or over) @ $20/person = ___________
_______Junior (under 18) @ $10/person = ___________
Names on membership:
______________________________________________________________________________
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Address:______________________________________________________________________
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Home Phone: (_____) ____________________ Cell Phone: (_____) ____________________
Email address: _______________________________________________________________
BLOG or Website URL: ________________________________________________________
Social Networks: ___________________________________________ (Facebook, Twitter, etc.)
Enclose a check payable to: Texas Jack Association for:
TOTAL = _______________
Please send completed forms and check to:
Rick Omohundro, Treasurer TJA PO Box 91 Salt Lick, KY 40371