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this Form Farm Name/Business ______________________________________________________________________________ Name(s) of those attending __________________________________________________________________________ Address ________________________________________________________________________________________ City_________________________________ State ___________ Zip ____________ Phone ______________________ Email ___________________________________________________________________________________________ Amount Enclosed: $ __________________
Meet at: Brennan's Farm Market, 701 Eighth St., Monroe, WI 53566 - 10:00am We will travel by car to each of the stops. Cost for WATA Members:
$22.00/person Phone: (920) 478-3852 Fax: (920) 478-9586
Charge to my VISA MASTERCARD (Circle one) Name on card: __________________________________________________ Card#: ________________________________________________________ Exp: _____ / ______ Signature:
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