Please include with your payment--   tube fees, kiddie fees, signed release form, names and
ages of children and your pager addresses so we can contact you directly about event changes.

Check or Money Order payable to MMKODA.

Due February 19, 2006

MMKODA
c/o Michele Dunefsky
21312 Village Green Circle
Germantown, Maryland 20878

Parent/Guardian: ______________________________________________________

Email :_______________________________________________________________

Pager :_______________________________________________________________

Children name(s):

                ______________________________________ Age:________

                ______________________________________ Age:________

                ______________________________________ Age:________

                ______________________________________ Age:________

                ______________________________________ Age:________

Adult $17.00 X ________ = ________

Children (age 5 and up) $17.00 X ________ = ________

Children (age 4 and below) $6.00   X ________ = ________

Total cost $________

Make check payable to MMKODA