Teddy Bear Leather Club Presents Bears in H.E.A.T  July 27th-29th, 2012

COST $60 ($70 If Postmarked After JULY 15TH) INCLUDES ALL MEALS AND EVENTS- YOU WILL RECEIVE A $5.00 REFUND AT REGISTRATION IF YOU BRING A NEW STUFFED TEDDY BEAR

NAME ________________________________________________

ADDRESS_____________________________________________

CITY, STATE, ZIP CODE ________________________________

PHONE NUMBER ______________________________________

EMAIL ADDRESS ______________________________________

CLUB AFFILIATION(IF ANY) _____________________________

I AM OVER 21 YEARS OF AGE(SIGNATURE)_________________________________________

T-SHIRTS ADDITIONAL $12.50 PLEASE SPECIFY ---SM MED LRG XL XXL

WOULD YOU LIKE TO HOST A COCKTAIL PARTY? YES NO

WOULD YOU LIKE TO PARTICIPATE IN THE SHOW? YES NO

SPECIFY TALENT_____________________________________

MAKE CHECKS PAYABLE TO: TBLC OF VIRGINIA

MAIL REGISTRATION TO :

 JERRY WORSHAM

4592 LONE PINE RD.

BURKEVILLE, VA. 23922

FOR MORE INFORMATION CALL (434)767-3361  or email jwbootbear@hotmail.com

 >