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RUBBER DUCKIE DERBY
OFFICIAL ADOPTION FORM
Derby will be
held Kinsale Day, 9/17/2011 in the afternoon after the tide
changes
$$$$$$
PRIZES $$$$$$
First:
$500
Second
$250
Third $100
To adopt your ducks, fill
in the blanks below and mail your payment to:
The Kinsale Foundation, P.O. Box
307, Kinsale, Va. 22488. More info: 804-472-4206
Name
(s) ___________________________________________
___________________________________________
Phone
number home: ________________________cell:
______________________
Address: ___________________________________________
Town:
______________________________ State: _______ Zip:
_____________
email:
_______________________________________________________
I want to
adopt ______ 1 to 4 ducks at a donation of $5 each.
_____________ The Quack Pack – 6 ducks for $25 (5 ducks at a
donation of $5 each, 1 free)
_____________ The Waddle Pack – 12 ducks for $50 (10 ducks at a
donation of $5 each, 2 free)
_____________ The Grand Quack – 25 ducks for $100 (20 ducks at a
donation of $5 each, 5 free)
You may pay by
check or credit card. Please make your check payable to
The Kinsale
Foundation
MasterCard,
VISA, Discover and American Express credit cards are accepted:
Credit Card
# ____________________________, Exp date ________, Sec. Code:
_____
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