LIONS HEARTLAND DOMINO TOURNAMENT REGISTRATION FORM

There will be four tournaments as outlined below including a fifth tournament for the amateur division. Please complete this form indicating your tournament choices below and we will e-mail you an invoice and instructions for payment. We will also e-mail you additional details regarding each tournament.

NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
E-MAIL ADDRESS:
		(THIS HAS TO BE A VALID E-MAIL ADDRESS)
CELL NO:
HOME NO:
WORK NO:
DO YOU PLAY DOMINOES ONLINE NOW?		NO YES
IF YES, WHAT SITE DO YOU PLAY AT ONLINE AT THIS TIME?
WHAT IS YOUR USERNAME?
I will play in the following LIONS HEARTLAND DOMINO TOURNAMENTS		Doubles draw for partner 7:00 PM March 31, 2011……..$50.00 entry fee. Singles 9 Rocks double elimination 8:00 AM April 1, 2011…….$50.00 entry fee. Singles 9 Rocks double elimination 8:00 AM April 1, 2011 Amateur Division …$30.00 entry fee. Ring Game Doubles- 12 games with 12 different partners 8:00 AM April 2, 2011……$50.00 entry fee.
Lions Club member?		Name of Club  City and State of club
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