Please print and mail this form with your payment to address at the bottom of the page.

Summer Eruption 2010   12th Anniversary
Horse Ranch RV Park
Fort Rock Oregon
July 16, 17 & 18th 2010

Name:

Address:

City:

State:

zip:


Number of tickets. $35 each:

Make checks or money orders payable to S.C.O.O.T.R. Inc.
Mail to:   S.C.O.O.T.R. Inc.
P.O. Box 3291
LaPine, Or 97739

No Refunds--Pre-registration Ends 6/30/10