AMPRA Spring Fling

 

 

 

 

 

 

 

 

Make check payable to: AMPRA

Send to: Loretta Phillippy, 3208 Andrea Avenue, Harrisburg PA 17109 (717-652-3865)

 

I plan to attend the Spring Fling. Enclosed is my check in the amount of $                           for myself and guest(s) as noted below.

 

PLEASE PRINT

Retiree’s Name                                                                                                 Phone                                 .

 

Retiree’s Address                                                                                                                                        .   

 

Guest(s) Name(s)                                                                                                                                        .   

 

Intending to be legally bound herby, I agree that participation in the event is entirely at my own risk, and I accept total responsibility for all claims and liabilities resulting from such participation, further agreeing to indemnify and hold AMPRA and its officers and directors harmless from all such claims, liabilities and expenses.

 

Retiree’s Signature                                                                                              Date                                 .