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Texas Shrine
Clown Association
Mid-Winter 2012 March 8-10th Tyler, Texas |
Name ____________________________________________________________
Ladys
name______________________________________________________
Shrine Center _____________________________________________________
Clown
Unit________________________________________________________
Clown
name_______________________________________________________
Clown office
Title_________________________________________________
Divan
Title ______________________________________________________
Address:
City _____________________________________________________
Street, Zip
Code___________________________________________________
Competition I will compete
in:
_____ Auguste _____Novice
_____ Whiteface _____Senior
_____ Character _____Hobo / Happy Hobo
_____ Tramp
_____One Man Skit
_____Two
Man Skit
Early Registration (post marked by 2/15/12)
____Clown and Lady $160.00 ____Clown only $100.00
Registration postmarked after 2/15/12
____Clown and Lady $180.00 ____Clown only $120.00
Send to: Jimmy Firecracker Jennings
315 East Brandon St.
Overton, Texas 75684
903-834-6656-(H) 903-521-0569-(C)