Date ______________

Name  _______________________________

Address ______________________________

City ____________________       State _______  Zip __________

Phone (_____) ______-______                 Cell (_____) _______-_______

E-mail ___________________
                                                                        OSRPA member dues~~~~~~~~~~~        $  10.00

Band # ___________________  Letter _______  Color __________________

                                                                        Perch/Entry Fee dues~~~~~~~~~~            $ 100.00

                                                                   Optional Average Speed ~~~~~~~~~~~               $25.00

                                                                                          Buy Back  ~~~~~~~~~~~             $15.00      

                                                                      Total Enclosed ~~~~~~~~~~~~~~~~         $_______

** Please Check Waive signature on your Express Shipping Label. Postman will deliver to house and put inside back door **

Make Checks Payable To:       Paul D Rueter

Ship Birds To:                         8961 NE Old Highway 97
                                                Madras,  OR  97741

                                                (541) 475-7479   Paul’s House Phone

                                                (541) 419-0590   Paul’s Cell Phone

                                                (541) 480-7593   Bob’s Cell Phone

**Note: Buy Back and Average speed fees are refundable if bird does not go to race.