LITTLE RIVER CASINO REGISTRATION FORM

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Please PRINT the information needed on the form below:

Name___________________________________________________________________

Address_________________________________________________________________

City______________________________________________________________________

State______________________________     Zip Code_________________________

Township_______________________________________________________________

Telephone Number:  (            )___________________________________________

Email____________________________________________________________________

Circle the date of the Casino Trip that you are registering for:

January 21
February 18
March 18
April 15		May 20
June 17
July 15
August 19		September 16
October 21
November 18
December 16

Make your check payable to  TRAVERSE CITY SENIOR CENTER
and mail or bring in with this form to the Traverse City Senior Center
801 E. Front St., Traverse City, MI 49686