Butler County Pheasants Forever
                                                           3255 Symmes Road
                                                            Hamilton, OH 45015




Banquet ticket purchasers receive a one year membership in either P.F. or Q.F.    
Better yet, receive a dual membership for just $20 more.


_______        I wish to become an Underwriter for $350
            Underwriters only, please circle shirt size for future reference   S  M  L  XL  XXL  XXXL
_______        Please send me tickets for  _______ couples at $100 per couple
_______        Please send me an individual ticket for $65
_______        I cannot attend, but I wish to renew my membership for $30
_______        Please send me _______ Gun Raffle ticket(s) at $5 each.
_______        I would be interested in serving on your chapter’s committee.  Please contact me.

_______        I prefer a Pheasants Forever membership
_______        I prefer a Quail Forever membership
_______        I want a dual membership in both P.F. and Q.F. for an additional $20
_______        New membership  _______        Renewal Membership      _______        Change of Address

             Other levels of Membership available and their benefits

______        $50               Rooster Booster          Cap and decal signifying Rooster Booster Membership ($20 FMV)
______        $100             Magnum                       PF Engraved Leatherman with Case ($32 FMV)
______        $250             Sponsor                       Lapel pin and Sponsor Edition Print of the Year ($130 FMV)
______        $1,000          Life                               Framed Life Member Certificate w/ Gold Pin
                                                                      and recognition in Annual Report
______        $10,000      Patron                          Patron plaque, PF Jacket
                                                                       and recognition in Annual Report (Payment plan available)

_______        I am enclosing a check for $______________ payable to Pheasants Forever.

_______        Please charge the above to my  _______  Visa         _______        Mastercard
Account # _____________________  Expiration Date ______________
Signature of card holder  ______________________________________

Please send my tickets to:

Name            ___________________________________________________________

Address        ___________________________________________________________

City   ______________________________State__________Zip__________________

Email address         ______________________________________________

Phone number (home)        ________________________________________


Print and send this completed form to:

Pheasants Forever
3255 Symmes Road
Hamilton, OH 45015


Please indicate your seating preference on this order form.  Thank you.

Seating Reservations Form

The tables at our banquet seat 8 people.  We strive to seat you with your friends and family members.  In order to do
that, would you please indicate whom you would like to have seated with you.  We will reserve your seating, and tell you
your table number when you arrive at the banquet.  Thank you.


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