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Maritime Motorsports Hall of Fame Inc.
4th Annual Formal Induction Dinner
Ramada Plaza Crystal Palace Hotel
499 Paul Street, Dieppe, NB

Saturday, November 14, 2009
Meet & Greet 5:30 P.M. - Dinner 6:30 P.M. - Induction 7:30 P.M.

Contact Name ...................................................................... Phone # ................................

Street ......................................................................................................................................

City ...................................................... Prov. ....................... Postal Code .......................

E-Mail Address ..............................................

Number of Tickets ........................... @ $75.00 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. ...............................................................

Number of persons attending Brunch at Hall of Fame, Nov. 15 at 10:00 am ........... @ $10.00 = $................

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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