Please print this form and mail with tax-deductible check to:

KALB, Duck Adoptions, P.O. Box 1089, Athens, AL 35612

Keep Athens-Limestone Beautiful

WACKY QUACKY DUCKY DERBY ADOPTION CERTIFICATE

Big Spring Memorial Park in Athens             Saturday, October 4, 2008

NEED NOT BE PRESENT TO WIN

Duck adoptions are $5.00 each (You may adopt up to 4 ducks on this adoption form)

Your duck adoption supports the work of Keep Athens-Limestone Beautiful, Inc.

NAME:________________________________________________________

ADDRESS:_____________________________________________________

CITY:___________________ ST:_____ ZIP:_______ PHONE:___________

EMAIL (optional): _________________________________________________

I'D LIKE TO NAME MY DUCK(s):

• 1.______________________________

• 2.______________________________

• 3.______________________________

• 4.______________________________

Official Use:   1._________  2._________  3._________  4._________