Name = ________________________________________________________________

Address = ______________________________________________________________

City _____________________________ St.______ Zip_____________ + ___________

Phone = ________ - _______ - ________________

_____ # of Fares @ $40.00 = _______________

Total Enclosed $_____________________

Make Check payable to: WNYRHS, Inc.
Send to: James Szymanski, 637 Borden Road, Cheektowaga, NY., 14227

VISA/ MASTERCARD Payment Info

Card Number = _________  _________  _________  __________ Exp Date__________

Name on Card ___________________________________________________________

Signature = _____________________________________________________________

No refunds after Saturday, October 4th, 2003 - Ticket Order Deadline.