NAME: __________________________________________________

ADDRESS: _______________________________________________

_________________________________________________________

PHONE: __________________________________________________

Mark one option:

_______ Sponsorship in my name

_______ Sponsorship in honor of ___________________________

_______ Sponsorship in memory of ___________________________

Please send this form along with a $50.00 check to:

Floyd Central Band Booster Association
P. O. Box 152
Floyds Knobs, Indiana 47119

Thank you for your participation in our sponsorship program!