MineLab Offer 15% Discount For All Military Personnel, Call For Discount Information

Event Pre-Registration Form

(PLEASE PRINT, COMPLETE AND E-MAIL)

YOUR FULL NAME: ____________________________________________

IF ATTENDING, YOUR SPOUSE: _________________________________

ADDITIONAL ATTENDEES:______________________________________

NEW TO METAL DETECTING AND GOLD PROSPECTING? _________

IF NOT, WHAT BRAND/TYPE OF METAL DETECTOR ARE YOU CURRENTLY

USING? ____________________________________________________

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Participant Shirt Size ______

Number of Adult Participant: ____   X $100.00 each = ____________

Dinner Companion Ticket: ________  X $10.00 each =   ___________­_

Additional T-Shirts:

Adult:  S____ M____ L____ XL____  X $20.00 each =   ____________

Adult:  XXL_____ XXXL                      X $23.00 each =   ____________

Youth: S____ M____ L____XL____   X $16.00 each =   ____________

Caps:  ______                                     X $17.00 each =   _________­__      

Additional Raffle Tickets

Nugget Bucket Raffle-Orange Tickets_____  X $5.00 each =   __________

MineLab Vanquish 540-Pink Tickets  _____  X $3.00 each =    __________

MineLab Vanquish 340-Green Ticket_____  X $3.00 each =     __________

MineLab Equinox 600 with

Wireless Headphone - Blue Tickets  _____  X $3.00 each =     ___________

Total                                                                                            ____________


Authorization for Credit Card

Please Print and Complete this Authorization 
All information will remain confidential.

 Name on Card:   ___________________________________________ 

 Billing Address: ____________________________________________

Credit Card Type:  _____ Visa _____ Mastercard   ____ Discover _____ AmEX

Credit Card Number:  ________________________________________

Expiration Date:  ______    ____________________________________

Card Identification Number: ______(last 3 digits located on the back of the credit card)

Amount to Charge:  $ ________________ (USD) 

I authorize MISSISSIPPI PROSPECTING AND DETECTING SUPPLY, LLC, to charge the amount listed above to the credit card provided herein. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.

 Cardholder – Please Sign and Date

Signature:  __________________________________________

Date:   __________________________________________

Return the completed and signed form to either  email address, a receipt will be sent to the email address received from.

Laurie@msprosdet.com or Perrycutshall@msprosdet.com 

or you can mail it to, and a receipt will be mailed to you:

Mississippi Prospecting & Detecting Supply
429-C County Road 313
Burnsville, MS 38873