| BUCA DI BEPPO
90 YORKTOWN MALL DRIVE
LOMBARD, IL. 60148
COCKTAILS @ 7:00 – DINNER @ 7:30
RSVP BY JUNE 15th TO charlene@mpks.org
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| NAME____________________________________________
ADDRESS__________________________________________
CITY, STATE, ZIP____________________________________
PHONE___________EMAIL___________________________ |
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| Banquet, Show Vat, & Award Sponsorship Registration Form |
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| ITEM ____ FEE __ QTY __ TOTAL
6’ Show Tank_______$60___________________
8’ Show Tank_______$75___________________
Banquet Ticket _____$42___________________
Award Sponsorship___?___________________Please name Award here:______________________________________
Total Enclosed____________________
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ENTER YOUR BANQUET & SHOW REQUIREMENTS BELOW
| There are a limited number of 6’ and 8’ vats available. Please reserve as early as possible. Plan on bringing your own bowl and net as MPKS has a very limited number of bowls and nets that will be available on a first-come basis |
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| General Release and Acceptance of Rules – I/we the applicant(s) have read the policies, rules and regulations, otherwise known as conditions as of the show contained in the entrant’s package and agree to abide by said condition. In addition, I/we the applicant(s) do expressly release the producer, MPKS, and the owner of the show site and their agents from any and all liability for any damage, injury or loss to any person or goods which may arise from the licensing and occupation of the exhibit space by the applicant(s), and agree to hold and save the producers and owners of the show harmless of any loss or damage by the reason thereof. I/we give permission to use my name, koi, descriptions, and other photographs, slides, videotape, or images taken of me or my koi for any and all purposes. To the best of my knowledge, my koi are not KHV survivors, nor have they been in contact with any koi known to have KHV.
Signature_________________________________________________________________________ |
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| Please address questions about the banquet to: Charlene Cebulski
Email: Charlene@mpks.org |
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| Please address questions about Vat rentals to: John Hall
Email: john@mpks.org |
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| Mail Registration Form and your check payable to: MPKS
Attn: Rhonda Mucerino
1106 E. Lowden Ave.
Wheaton, IL. 60189 |
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Entry is not complete until your signed Registration Form has been received along with payment. If tanks are available, late registration wil
