Civil War 2100: Preacher's Revenge

You may print this form, fill it out later or fill it in online and print this form. Send to:
Todd Shenker (Gruber)
8823 Hickman Rd. #819
Urbandale, Iowa 50322
Voice Phone Number: (515)251-7200
Action Jack's Paintball Park - Voice Phone Number (515)791-2515
Remember - Pre-registration means the form and fees ($20, pre-registered individual player) are mailed (and postmarked) or hand delivered to the above address by May 6, 2000. Walk-ons are welcome at the non pre-registered rate of $40 per player

Please provide the following contact information:

First name

Last name

Team Name

Email Address

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Home Phone Number

Total Number of
Players registering:

Total Amount sending
for pre-registration

Additional player's registered (team/group registration)

use back of page if not enough room for teammates.

First name
Last name
Team Name
Email Address
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Home Phone Number
Total Number of Players registering:
Total Amount sending for pre-registration

Civil War 2100: Preacher's Revenge

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