FORM

4820 Green Hill Ct. Anacortes, WA 98221 360 293-8550 ray.bloom@comcast.net
 * Please print this page and return to Ray, with payment, as soon as possible; __not later than July 15__**
 * Ray Bloom**

Number of people attending dinner _____

Number attending picnic _____

__Names (for dinner nametags):__

_

_

__Dinner entrees (indicate choice by number of people)__
 * __Roast Prime Rib Au Jus__ ____
 * __Flame Broiled Salmon__ ___