| First Name: |
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| Last Name: |
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| Event Address: |
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| Event Address # 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| Name of Your Event:: |
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| Date of Your Event:: |
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| Time of Your Event:: |
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| Special Instructions:: |
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Interested in Lazer Tag? |
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Interested in Live TV? |
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Interested in Space Jumps? |
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Interested in Pay-Per-View Events? |
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Interested in DJ Hero? |
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Interested in Xbox Live or the Internet? |
Catering Requests:
[Yes, we do cater!! ] |
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Video Game Requests:
[please include the number of copies of each game(s) you wish to have at your event]
[please include any request for age limits on certain games or to limit games available at your event]
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