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*Loft Name :

*Contact Name:

*Address:

*City/State/Zip:

*Email:

Team Entry only, No Single Bird Entry

*Phone:

Date: 19-May-2012

Pigeons:

example: 12345-AU10-ARPU

10 Bird Team = $2,600 - two of the 10 birds are backup

Back Up:

Back Up:

Form Total:

$

Ship Birds to: Merl Emerson Phone 864-476-5566

P.O. BOX 632

WOODRUFF SC 29388

Please make checks payable to: Merl Emerson

150 Anderson Drive Roebuck,S.C. 29376