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LMLOWIFF.1y 2012 <br /> Return to: Roseville Parks & Recreation, 2660 Civic Center Dr. Roseville, VN 55113. <br /> To register by phone, call 651-792-7110. <br /> Name: Home Phone: Work Phone: <br /> Address: <br /> Street City Zip Code <br /> Email: <br /> X $6 per person = $ Arrival Time: <br /> Total # participants Total Fees Due I,' Choice 2 11 Choice 311 Choice <br /> First, Last Names - Children: First, Last Names - Adults: <br /> Date of Birth (REQUIRED) Date of Birth <br /> Method of Payment: Cash Check VISA MasterCard <br /> (Please make checks payable to Roseville Parks & Recreation) <br /> Name on Credit Card: Expiration Date: <br /> Credit card #: Signature of Credit Card Holder: <br />