2014 23RD ANNUAL STAR OF THE NORTH ONE LOFT CHALLENGE
STAR OF THE NORTH – One Loft Race Entry Form
Ship birds to:
Rich or Joyce Bemboom
13144 St. Hwy 23
Milaca, MN. 56353- 2718
Make checks payable to: STAR OF THE NORTH 1 LOFT
Questions? Call Rich or Joyce Bemboom at: 320 -294-5429
Breeder’s Name: ( Please Print) _____________________________________________________________
Loft Name (optional): _____________________________________________________________
Address: _____________________________________________________________
City: __________________________ State: ___________ Zip: ___________
Phone Number: __________________________Club Name______________
Entry fees: $75 per bird or 3 Birds for $200.00, Back up Bird $25.00 NO PERCH FEE!
# Of Birds ______ Band #s & Color
1)_______________________________________________
2)_______________________________________________
3)_______________________________________________
Back up Bird
________________________________________________
Date: _______________ Check # ___________ or Cash ___________
Total Amount Paid $____________
If sending more then 3 Birds please fill out an additional Entry Form
~ Loft Manager: Rich / Joyce Bemboom
~ Updates and additional information can be found at our website ~ MMRPC.COM