Name ______________________________________________________________

Street ______________________________________________________________

City, State, Zip ______________________________________________________

Phone numbers: (daytime) ________________ (evening) _______________

Enclosed is a check or money order in the amount of $ __________.

I am ordering ________ ticket(s) at $85 each. I understand this includes bus transportation
and a game ticket, and the ticket(s) will be given to me on the bus.

Membership No. ________

□ If anyone is in need of handicap assistance please check box so that arrangements can be
made for seating at the stadium.

Mail to: Browns Backers of Greater Dayton

PO Box 292183, Kettering, OH 45429-0183