Professional Entry Application
PEPSI MIN-DAK PRO AM
Aug 30
Name: ____________________________________________
Address: __________________________________________
City:__________________ State: _________Zip: __________
Phone:_____________ Cell Phone:______________________
Social Security #: ____________________________________
Email Address_______________________________________
Entry Fee $200.00
All cancellations will receive full refund less $50 administration fee.
Send entry to:
Pro Entry
Randy Patnoe
PO Box 46
Milbank, SD 57252
605 432-4124
