Name:
Address:
City:	State:   Zip Code:
Your E-mail:
Phone:	(include area code)

There is a $30 entry fee for each player, which can be either
paid at the door or mailed in advance to:

• 306 West River Drive
• Davenport, IA 52801

Please make checks payable to EICCD Foundation.

If you have any questions about the tournament please contact
Honey Bedell at 563-336-3302.