• Please provide the following contact information:

  Name
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  Work Phone
  Home Phone
  FAX
  E-mail
  Club Affiliation
  Car Corral-$20.00/space	012345678910
  Swap Meet-$20.00/space	012345678910
  Comments

   

  Print this form from your browser and submit to the address below.

  Send the completed form and a check of $20.00 per space to:

  Please make checks out to The BMR Foundation.

      The Burton-Middlefield Rotary

      P.O. Box 516

      Burton, OH 44021

 

   For further information contact:

•    Ray Gilbert    440-564-9361