Name: _______________________________________

Address: _____________________________________

             _____________________________________

City, State, ZIP:  ______________________________

Phone:   _____________________________________

Year graduated from Burt Twp. School: ___________
(or years attended BTW)

E-mail address:  _______________________________
 

Send this for and your check for $10.00 made out to "Polar Bears Den" to:

Polar Bears Den
Attn: Gee Petruske
P.O. Box 442
Grand Marais, MI  49839