OASIS 25

           Dealer Registration Form

Print,complete and mail with your check,
made out to:

     OASFiS
     PO Box 323
     Goldenrod, FL  32733-0323


Business Name:________________________________

Dealer Name:__________________________________

Address:______________________________________

City:___________________State:____Zip:________

Telephone:_________________

email:________________________________________

Number of Tables:_____ X $65= $______

Extra Memberships:____ X $30= $______*

              Total enclosed: $______

Type of Merchandise:__________________________

Special Needs:________________________________

______________________________________________

______________________________________________
*Extra memberships are $30/ ea through 1/1/12
                       $35/ ea through 4/30/12
                       $40 after 4/30/12