2000 International Gold Cup

							                         2012 International Gold Cup
                            Official Race Program
                                  Order Form


The Virginia Gold Cup Association is offering for advance sale its Official
Race Programs. Advance purchased programs are only $4.00 each—a
discount over the regular $5.00 on race day!

Advance purchased programs will be delivered to your tent by 10:00 AM on
Race Day. Note: Programs can only be ordered in advance for party
tents. The order cut off date is Noon on Monday, October 15, 2012.
North / South Party Tent # __________

Name on Tent:________________________________________________________

Contact Name:________________________________________________________

Telephone #: _______________ E-Mail Address (required) _____________________

Please indicate quantity in increments of 25:__________ @ $4.00 each = ___________

              ____Visa         ____Master Card       ____Check Enclosed

_______________________________________            ____________________
Card Number                                        Expiration Date


Cardholder Signature


___________________________________
Cardholder Name (please print)

Please mail or fax to:

                           Virginia Gold Cup Association
                                    P.O. Box 840
                            Warrenton, VA 20188-0840
                            Fax:          540-349-1829
                            Phone:        540-347-2612