REQUEST FORM

Please print, complete, and mail with check or money order for your donation of $12.00 to:

Bill Groeneveld / Eagles '76 & Friends

955 La Paz Road

Santa Barbara CA 93108

YOUR NAME:

YOUR MAILING ADDRESS:

YOUR E-MAIL ADDRESS IN CASE

WE NEED TO CONTACT YOU:

Please complete legibly!

Your CD set will ship within 3-5 days from when we receive your request!