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		Maritime Motorsports Hall of Fame Inc. 5th Annual Formal Induction Dinner New Brunswick Casino, Magnetic Hill (guest Speaker is scheduled to be Derek Oland Executive Chairman, Moosehead Breweries) Saturday, November 6th, 2010 *Meet & Greet 5:00 P.M. - Dinner 6:00 P.M. - Induction 7:00 P.M.* *Contact Name ...................................................................... Phone # ................................* *Street ......................................................................................................................................* *City ...................................................... Prov. ....................... Postal Code .......................* *E-Mail Address ..............................................* Number of Tickets ........................... @ $80.00 each = $ ..................... (tables of 8) Following is a list of attending guest(s) (Please print as this is how your name tag will read) *1. .............................................................. 5. ...............................................................* *2. ............................................................... 6. ...............................................................* *3. ............................................................... 7. ...............................................................* *4. ............................................................... 8. ...............................................................* PAYMENT: Cheque or Money Order payable to MARITIME MOTORSPORTS HALL OF FAME INC. Enclosed is my cheque / money order in the amount of $ ........................................... Please return order form and cheque / money order to: Maritime Motorsports Hall of Fame Inc. 5 Hooper Lane, Petitcodiac, NB E4Z 0B4



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