Registration form

If paying through the mail, please print out this page, complete the form, and mail to the address on the right with your payment of $40.00.

If paying with Paypal funds, please click the PayPal link below and email your registration info to address below.

Name:

Address:


Phone number:

Email address:


Paying with (circle one) Check / Money Order / VISA or MC

Credit Card number (if applicable):


Expiration date:


Signature:


Who would you like to be seated with? (we can accommodate groups of up to 12 people):

Your canceled check or credit card statement will be your receipt.

Bounced checks will incur a $30.00 service charge.

For more information, please email:

plevea@roadrunner.com

Mailing Address:

If paying by mail, please send your
completed form to:

Patty LeVea
PO Box 262
Clarence Center, NY  
14032

Event Address:

Leonard Post, Jr. Post
VFW
2450 Walden Ave.
Cheektowaga, NY  14225