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Mail to:
Lodge 15 Secretary/Treasurer
Robert Hull
P.O. Box 81
Wiarton Ontario N0H 2T0
Canada

The winners will be announced at the ISMA Grand Ball on February 10, 2012 in Owen Sound

Name: ______________________________________________

Address: ____________________________________________

City: _______________________________________________

State/Province: _____________________________

Postal Code: _______________________________

Country:______________

Phone: (___)___________

Number of tickets: ___________ tickets are $5 (CA) each

Amount Enclosed: ___________

Your tickets will be mailed to you. Winners need not be present to win.

License #M678872


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