Pre-Registration Form

ATLANTIC CITY POLAR BEAR CLUB

Register for the MSAA Polar Bear Plunge
January 1st, 2014
Pre Registration Fee: $25.00 (will include t-shirt)

BY PRE-REGISTRATING YOU WILL RECEIVE A CHANCE TO WIN A PRIZE PACKAGE AT RESORTS CASINO THAT CONSISTS OF AN OVERNIGHT STAY,
A GOURMET DINNER FOR TWO, AND TWO REVUE TICKETS
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Phone:

Email:
Comments:




MAKE CHECKS PAYABLE TO  "MSAA"

MAIL CHECKS TO:
ATLANTIC CITY POLAR BEAR CLUB
816 PERSIMMON LANE
LANGHORNE, PA 19047