Please make checks payable and direct all correspondence to:
Michigan Ticket Dept.

______________________________________
Name (Please Print)
______________________________________
Address
______________________________________
City/State/Zip
_______________________________
Home Phone Number
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Daytime Phone Number

Date	Game	Level	Qty.	Price	Amount
Nov 10	Double Pump All-Stars	Gold	____	$6.00	$________
Nov 14	Team Prestige	Gold	____	$6.00	$________
Nov 19	Oakland	Gold	____	$6.00	$________
Nov 23	Detroit	Gold	____	$6.00	$________
Nov 27	Western Michigan	Gold	____	$6.00	$________
Dec 4	Chattanooga	Gold	____	$6.00	$________
Dec 8	Kent	Gold	____	$6.00	$________
Dec 23	Duquesne	Gold	____	$6.00	$________
Dec 28	Towson	Gold	____	$6.00	$________
Jan 2	Colorado State	Gold	____	$6.00	$________
		Service Charge			$5.00
		Individual Ticket Total			$________

Last updated: Whateverday, 00-Sep-1999 00:00 EDT