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When: Friday, October 9 – Saturday, October 10

8:00am – 5:00 pm each day

Where: Southwest Church of Christ, 2600 S. 124th St., Omaha, Nebraska

                                             

_____________________________________________________________________________________

REGISTRATION INFORMATION REQUIRED

 NAME

 

CLOWN NAME

 

ADDRESS / CITY / ZIP CODE

 

PHONE

 

EMAIL

 

COAI MEMBERSHIP NUMBER

_____________________________________________________________________________________

COST

OMAHA WILD CLOWN-DUM MEMBERS                                           $40.00

 

NON MEMBERS                                                                                   $55.00

 

Mail check & completed form to:                                    Will you be attending the pizza party

                                                                                       on Thursday, Oct 8? Yes____ No____

Omaha Wild Clown--‐Dum                                             Do you have a skit you want to

PO Box 241683                                                              perform for Paula? Yes_____ No____

Omaha, NE 68124                                                          Will you be attending the “no host”

                                                                                        dinner at Big Mama’s on Saturday at

Questions????                                                                4:00p? Yes_____ No________

Contact Teresa Ziska

omahawildclowndum@gmail.com

Or

402‐896‐1781

 

 

 

OR

JOIN OWC FOR $12.00 AND PAY $40.00 MEMBER RATE AND SAVE 3 BUCKS

 

CLICK HERE TO DOWN LOAD REGISTRATION FORM 

 

 

 

 

 

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