2016
Member FDIC.
Take me out
to the
game!
May 14th
6:10pm Game
Brewers VS. Padres
Package Includes:
ICE
R PR
BE
110
MEM
$
PER
ON
PERS
GAME TICKET
DELUXE MOTORCOACH
TRANSPORTATION
FULL BUFFET &
GRATUITIES
Add $20 for Non-Members
Kids 8 Yrs. & Up Welcome
at Member Price
Subject to change. Must be a Premier Club Member at time
of registration to get Member Pricing.
Exclusive Miller Lite Deck Seats
& Full Buffet
Grilled Italian Sausage with Peppers & Onions
Klement’s Hot Dogs & Grilled Sirloin Burgers
BBQ Chicken Breasts
Spring Salad & Red Wine Vinaigrette Coleslaw
Tater Tots
Popcorn & Peanuts
Assorted Cookies & Brownies
2 FREE BEERS per ADULT
& Unlimited Soft Drinks
Please return this form along with payment by APRIL 30, 2016.
Make checks payable to IXONIA BANK. Stop by any one of our branch locations, or mail it to:
Ixonia Bank • Attn: Lauren Wheeler
PO Box 110 • Ixonia, WI • 53036
MILWAUKEE BREWERS GAME - REGISTRATION FORM
Traveler # 1
PC Member?
YES
NO
Nickname
(Legal Name)
Address
Phone
Traveler # 2
PC Member?
YES
NO
Nickname
(Legal Name)
Address
Phone
Please note any special requests or travel preferences on the back.
LIABILITY WAIVER, RELEASE OF CLAIMS, AND INDEMNIFICATION. THE UNDERSIGNED DOES HEREBY AGREE TO RELEASE, HOLD HARMLESS AND INDEMNIFY
IXONIA BANK AND ITS EMPLOYEES, AFFILIATES, OFFICERS AND DIRECTORS (“BANK”) FROM AND AGAINST ALL CLAIMS, LIABILITIES AND EXPENSES, WHETHER IN
CONTRACT, TORT, STATUTE OR OTHER LEGAL THEORY ARISING FROM ANY PROPERTY LOSS/DAMAGE, PERSONAL INJURY OR DEATH RESULTING FROM ANY ACT
OR OMISSION BY BANK (EXCEPT RECKLESS OR INTENTIONAL MISCONDUCT) ASSOCIATED WITH THE ABOVE-NAMED TRIP OR EVENT.
Traveler #1 Signature Office Use:
Date
Traveler #2 Signature Date
Date Received __________Time Received ________ Initials _____# Members Attending ____ # Guests Attending____