Membership/Banquet Forms

AMERICA ANNUAL: $25 via Check* $27.50 via Credit Card** AMERICA LIFETIME: $300 via Check* $307 via Credit Card** To pay via PayPal please visit: www.caulifloweralleyclub.org PAYMENT OPTIONS • Check • Money Order

*To pay via Check or Money Order mail form to: Cauliflower Alley Club 10823 Indian Hills Court, Unit 29 Seminole, FL 33777 **To pay via Credit Card mail this form to above address with

CANADA ANNUAL: (U.S. Funds) $35 via Check* $37.50 via Credit Card** OVERSEAS ANNUAL: (U.S. Funds) $45 via Money Order* $47 via Credit Card**

CANADA LIFETIME: (U.S. Funds) $450 via Check* $460 via Credit Card** OVERSEAS LIFETIME: (U.S. Funds) $550 via Money Order* $565 via Credit Card**

Credit Card information ***To pay via PayPal go to www.caulifloweralleyclub.org/shop and follow instructions. Name _____________________________________________ Ring Name _________________________________________ Address ___________________________________________ City __________________ State _________ Zip __________ E-mail _____________________________________________ Phone _____________________________________________ Accomplishments in wrestling (or send resume) ___________ __________________________________________________ ___________________________________________________

To charge membership via mail Credit Card # ______________________________________ Amt. Charge _________ Expiration Date ________________ Name of credit card holder ___________________________

2021 CAC BANQUET/BOCKWINKEL BLOWOUT

Gold Coast Hotel & Casino in Las Vegas, NV Blowout: APR 27, 2021 TICKET OPTIONS Banquet: APR 28, 2021 MEMBERS PAYING VIA CHECK: Total number of Tickets You DOMESTIC: Wish to Order __________ $125 per person for both nights

PRINT & MAIL FORM TO: CAULIFLOWER ALLEY CLUB 10823 INDIAN HILLS COURT UNIT 29 SEMINOLE, FL 33777

NO BANQUET TICKETS SOLD AT DOOR!

ALL ORDERS BY CHECK MUST BE IN U.S. FUNDS, INCLUDING CANADIAN and OVERSEAS ORDERS

CANADIAN: $125.00 (U.S. Funds) per person for both nights

MEMBERS PAYING VIA CREDIT CARD:

DOMESTIC: $127.50 per person for domestic orders for both nights

CANADIAN: $131.00 per person for Canadian residents for both nights

OVERSEAS: $132.00 per person for overseas residents for both nights

MEMBERS PAYING VIA PAYPAL: Please visit: www.caulifloweralleyclub.org (List the RING NAME of each person who will be using the tickets) PRINT NAME CLEARLY ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________

Enclosed is a check in the amount of _____________ or charge my credit card in the amount of ______________ for _____ tickets.

If paying by credit card: Credit Card #__________________________________ Amt. Charge___________ Exp. Date____________ Name of credit card holder ______________________ E-mail __________________________________________ *To pay via Check or Money Order mail form to: Cauliflower Alley Club 10823 Indian Hills Court, Unit 29 Seminole, FL 33777 **To pay via Credit Card mail this form to above address with Credit Card information

Cauliflower Alley Club 10823 Indian Hills Court, Unit 29 Seminole, Florida 33777

55 th Anniversary of The CAC Gold Coast Hotel/Casino, Las Vegas April 26 to April 28 2021