Attached to which Legion or Group?
VENDOR / RE-ENACTOR NAME:
ADDRESS:
CITY:
STATE:
ZIP
TELEPHONE
FAX
E-MAIL ADDRESS:
Portrayal of : Legionaire
, Senator
, Citizen
, Gladiator
, Praetorian Guard
, (check one or more)
Other:
To complete registration send photograph by mail or by E Mail in JPG format to the address below.
Notes:
Champion One Productions, Inc.,
36181 East Lake Road, # 185
Palm Harbor Florida, 34685,
Tel: 727-787-2158, Fax: 727-787-8476
E mail: gbarbosa@tampabay.rr.com
