“Polka Review with Larry & Cindy”

620 KHB Irwin/Pittsburgh

New Recording Order

Quantity Price each Total

_______ “Remembering Gene Casciola” $15.00 _____

I understand postage and handling is included in the price.

____ I would like to receive CD & Cassette Polka Catalog from

Sygan SNPJ Lodge # 6

____ I would like to receive a current dance schedule for Sygan

SNPJ Lodge # 6

Name___________________________________

Address__________________________________

City_________________________State________ Zip_________

Please send check or money order payable to:

Sygan SNPJ Club Lodge # 6

Send to:

Sygan SNPJ Lodge # 6

Attn: Jim Curl

540 Third Ave.

Bridgeville, PA 15017

Thank you for supporting Polka Music!

Larry & Cindy Placek