2000/2001

Here's Looking At You, Gene!
Application



NAME:_____________________________________________________________

ADDRESS:__________________________________________________________

__________________________________________________________

CITY:__________________________STATE:_____ZIP:_____________

COUNTRY:___________________________________________________

PHONE NUMBER:________________________

EMAIL:___________________________________

BIRTHDATE:___________________________




*Make checks or money orders payable for $30 (US & Canada) and $45 (overseas) to: HLAYG



HLAYG
W238N3353 Pine Hill Ct. Pewaukee, WI 53072


phone:(262)691-9767
email to:
Robbin Runtas



Here's Looking At You, Gene!


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