Ticket order form

Just print and complete this form, and mail with your check payable to Withlacoochee Bluegrass.

Please include a stamped, self-addressed envelope for ticket return and camping confirmation to:

Withlacoochee Bluegrass

PO Box 180

Dunnellon, FL  34430

for information call (352)465-1842

Name:              ____________________________________________

Address:          ____________________________________________

City/State/Zip:  ____________________________________________

Motor Home?       Travel Trailer?       5th Wheel?        Tent?                (circle one)

Length of camper in feet?   ___________________________________

Campsite with Electric hookup if available ($39)?        Yes  or  No  (circle one)

Primitive camping ($15) ?                                                Yes  or  No  (circle one)

Number of tickets:   ______ Adults     ______ Juniors (age 13-15)    ______ Child(ren)  (age 6-12)

(These are advance tickets for the whole weekend)

Total amount enclosed:    $ ___________

SAVE BY BUYING YOUR ADULT WEEKEND ADVANCE TICKETS FOR ONLY $50!

(gate price: $55)

Children, age 6-12, 3 days:  $3

Juniors, age 13-15, 3 days:  $12

Primitive camping, 3 days:  $15

RV electric/water hookup, 3 days:  $39