Return Form with Payment
Questions? Email: jjwalsh535@optonline.net
Name: __________________________________________
Contact number:__________________________________
E-Mail: __________________________________________
Address: ________________________________________
City: ___________________State/Zip: ________________
# of Players_______ (at $100 per player)
Total Amount $_________________
Names of additional players:
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Please Mail Check Payable to:
St. Virgil Academy HSA (Poker)
St. Virgil Academy HSA
Attn: Casino Night
238 Speedwell AveMorris Plains, NJ 07950