Print this page, fill out information and mail with payment to:
Rollerdome Inc.
320 East Main Street
Anoka, MN 55303
| Name: | _____________________________________________ |
| Address: | _____________________________________________ |
| City, State, Zip Code: | _____________________________________________ |
| Phone: | _____________________________________________ |
| Quantity | Price | Total | |
| Season
Pass (4 free buddy passes) (1 Season Pass Holder T-Shirt) . |
x 169.00 | $ | |
| Multiple
Pass Discount (subtract $10.00 for each pass) |
x $10.00 | -$ | |
. |
TOTAL | $ |
.
Shirt Size: S___ M___ L___ XL___ XXL___
.