| Cost | ______Single ($35) | _____Couple ($65) |
| Your Name | _______________________________________________________________ |
| Spouse's Name | _______________________________________________________________ |
| Address | _______________________________________________________________ |
|   | _______________________________________________________________ |
| Phone # | _______________________________________________________________ |
| Email Address | _______________________________________________________________ |
|   | Sunday August 6, 2000 George Wyth State Park |
|   | 12:00 p.m. |
|   | Family Picnic |
| Send amounts listed above to: | Denise Osgood Tudor |
|   | 311 Russell Road |
|   | Waterloo, IA 50701 |
|   | (319) 233-7703 |
|   | email: denisetudor@yahoo.com |