DISTRICT 14 MX BANQUET SATURDAY January 17th, 2015 Best Western Sterling Inn & Waterpark 34911 Van Dyke Avenue Sterling Heights, MI 48312 (586) 979-1400 Doors open at 5:00pm Dinner at 6:00pm Sorry NO tickets will be sold at the door. YOU MUST PURCHASE A TICKET TO PARTICIPATE IN ANY PART OF THE BANQUET! Information must be postmarked NO LATER than December 20th, 2014 Make checks payable to: District 14 MX NAME____________________________________________________________________ ADDRESS__________________________________________________________________ CITY______________________________STATE________________ZIP________________ PHONE________________________Email_______________________________________ TICKETS Name____________________________ Adult (11yrs & Up) Child (4-10) $30 $20 Quantity Quantity ________ ________ Child (0-3) Free Quantity ________ Name____________________________ ________ ________ ________ Name____________________________ ________ ________ ________ Name____________________________ ________ ________ Please attach a separate sheet for additional names ________ Total Tickets_________x$30= _________ ________ x$20= _________ Total Enclosed $ ____________ JACKET INFO Rider Name_________________________________________________________ Class#1___________________________ Jacket Size__________________ Class #2___________________________ Jacket Size__________________ Class #3___________________________ Jacket Size__________________ Youth: Small (6-8)= YS Medium (10-12)= YM Large (14-16)= YL X-Large (18-20)= YXL Adult: Small= AS Medium= AM Large= AL X Large= AXL XX Large= A2XL st Please note we will print 1 names on jacket ONLY. Last name and/or racing number can be added at an additional fee of $5.00 per name or number. PLEASE MAIL FORM TO: Baja Acres 8683 Birch Run Road Millington, MI 48746 Any questions please contact Baja Acres (989)871-3356