Are you a member of the KCBS? Yes     No

Are you certified as a judge by the KCBS? Yes     No     If yes, KCBS #:

Are you a member of a cooking team? Yes No     If yes, team name:

Please list any major contest(s) which you have judged:

One free tee-shirt per team please indicate size: 3X 2X 1X L M

Additional tee-shirts $20 ea. indicate amount and sizes: 3X 2X 1X L M

For more information, please contact Dan Skaggs at 502.259.8734, e-mail skaggs_daniel@yahoo.com, or visit us at www.smokinontheriver-jeff-in.com