Fillable Printable Birthday Coupon Form

Birthday Coupon Form

St. Jerome’s Bingo

SJRS Gym

Tamaqua, PA 18252

Doors Open at 4:00 p.m.

Bingo Starts at 6:00 p.m.

Birthday Coupon Form

Date:

____________________________________________

Name:

Street Address:

City, State, Zip Code

Month of Birth:

Please print all information. Please return this completed form to Bingo. The

Birthday Coupon is good for $5 Off of Admission to be used one time during the month

of your birthday

Birthday Coupons are sent out for the month of your birthday. If you are not on

the list, please fill out this form and return it to Bingo. Please keep your address

current. If the Birthday Coupon is returned to us, your name will be removed from the

list.