SEASONAL LAUNCH APPLICATION 2010
(Please Print and fill in this Form and Mail it along with your Payment To:
Mitchell's Bay Marine Park Limited
3 Allen Road,
Mitchell's Bay, Ontario
N0P 1L0

NAME: ________________________________ PHONE: _________________________(Home) ADDRESS: _____________________________ PHONE: _________________________(Work or cell) CITY: ____________________________ PROV/STATE: ________________ POSTAL CODE/ZIP CODE: ___________________ Email: _____________________________________ Vehicle Plate Number: ________________________ Make and Model: ____________________________ Color: _________________ Trailer Plate Number: _________________________ Boat Make or Name: __________________________(ie description) Registration #: _______________________________ Price $ 229.00 Plus Taxes

Payment by:

Cash Cheque US Visa MC Amex

All cheques payable to Mitchell's Bay Marine Park Limited

Office use only Pass Number: ______________________ Launch pass distributed: YES NO

Mitchell's Bay Marine Park Limited 3 Allen Road, Mitchell's Bay, Ontario N0P 1L0 Tel: (519) 354-8423 Fax: (519) 354-3289

A Visa, Mastercard or American Express deposit is required at the time of booking to hold your spot More Information on Mitchell's Bay