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Name: <br />Address: <br />Date: Wednesday November 12, 2008 <br />Cost: $72 , or $74 for nonresidents younger than 62 <br />Depart: 9:40am — North Entrance of Roseville Skating Center <br />Return: 5pm, approximately <br />Program #: 7101.149 <br />Registration Deadline: <br />Oct 31 <br />or sooner if spaces fill <br />Requested refunds are <br />subject to a service fee. <br />Register: By phone with a Visa or Mastercard — (651) 792-7110 <br />By Mail or in person at: <br />Roseville Parks & Recreation <br />2660 Civic Center Drive Roseville, MN 55113 <br />-; <br />Meal Choices: Participants will order off a selected menu. <br />Parks 8 ReaeOlc- oopadr l <br />Chanhassen Dinner Theater- 7201.149• Wednesday November 12, 2008 <br />Special Needs, Accommodations, or Allergies <br />Cardholder Name <br />Birthdate: <br />Date: <br />Visa/ MC Act 4 <br />Fee: <br />Signature: <br />City: <br />Phone: <br />Exp <br />Total amount enclosed <br />Trip is presented by Roseville Parks and Recreation Department and co hosted with New Brighton <br />Zip <br />