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Please send a copy of this order form, along with payment by
check or money order, made payable to DAVE CHRISTIAN to:

MIDWEST REGIONAL WRESTLING
10103 Joann Drive
Columbus, Indiana 47201

Please allow 4-6 weeks after the April 1, 2005 show for delivery


NAME: ______________________________________________

ADDRESS: ___________________________________________

CITY: __________________ STATE: _________ ZIP: ________

PHONE: _____________________________________________

E-MAIL: _____________________________________________


DVD'S DESIRED: ___________________________ AT $10 EACH DVD

T-SHIRTS DESIRED: _____________________ AT $15 EACH SHIRT

SHIRT SIZES DESIRED: _____________________________________

SUBTOTAL: ______________ + $5 SHIPPING & HANDLING PER ITEM

TOTAL AMOUNT ENCLOSED: ________________________________


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