1) Name__________________________________________________________________________________
2) Address________________________________________________________________________________
3) City/State/Zip__________________________________________________________________________
4) Phone-home___________________________________________________________________________
5) Phone-cell_____________________________________________________________________________
6) Email___________________________________________________________________________________
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I would like______________ shares in Tech No Prisoners @ $600.00 per share=___________________ (total)
Please make checks or money orders payable to: Charlie Horse Racing—3
Print the form, fill it out, and mail it to:
Charlie Horse Racing
13902 Rutland Road
Goshen, KY 40026