Hoosier Park Registration Form

Hoosier Park
Saturday, July 12, 2008

Send registration form to:
Linda Brown, Scholarships/Financial Aid - LU 245 or
Rhonda Small, University Development - AL 249

Name:_____________________________________________

Dept: _________________________ Phone: ______________

Email: ____________________________________________

___ Yes, I would like to get a free gaming card worth $10.00 toward
slot machine play - please provide the following information:

Address: _______________________________________________

DOB: _________________ Driver's License #: _________________

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