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FIRST & LAST NAME

EMAIL

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ADDRESS (Including City, State, and Zip)

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1 Ticket - $100.00

2 Tickets - $200.00

3 Tickets - $300.00

4 Tickets - $400.00

Buy 5 Get One Free! - $500.00

7 Tickets - $600.00

8 Tickets - $700.00

9 Tickets - $800.00

10 Tickets - $900.00

Buy 10 Get Two Free! - $1000.00

Wright Family Center

PO Box 243

Dieterich, IL 62424

217-925-5554

Lobby and Gymnasium hours:

Sunday 12pm-5pm

Monday - Friday 8am -8pm

Saturday 9am-6pm

Make Payments to:

Village of Dieterich - Wright Family Center

P.O. Box 243

Dieterich, IL 62424

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