PLEASE CIRCLE YOUR GAME OF CHOICE:

TUES. OCT. 28 @ 7PM vs JETS

TUES. NOV. 18 @ 7PM vs LIGHTNING

TUES. DEC. 2 @ 7PM vs SENATORS

TUES. FEB. 10 @ 7PM vs OILERS

THUR. FEB. 19 @ 7PM vs PREDATORS

Limit two (2) tickets per student. All forms must be submitted no later than one (1) week prior to the selected game. Families with more than one child participating in the program must select different games. Do not bring this to a New York Islanders hockey game. You must mail or fax this form to receive your tickets. Tickets will be mailed to all students. Tickets not redeemable as part of a group event. *Game exclusions apply. While supplies last. This program is open to elementary school students grades one-six.

ADDITIONAL TICKETS:Number of Additional Tickets Purchased: _________________(Available at $25 each)

METHOD OF PAYMENT:Make check or money order payable to:NEW YORK ISLANDERS

AMEX MC VISA Check

Card #__________________________________________

Exp. Date________________________________________

Name on Card ____________________________________

Signature _______________________________________

MAIL TO:NEW YORK ISLANDERSATTN: BLADES FOR GRADES/ANN RINA1255 Hempstead Turnpike, Uniondale, NY 11553FAX: 516.501.6850

Student Name:__________________________________________________

Parent’s Name: _________________________________________________

Address:_______________________________________________________

City: __________________________________________________________

State: ________________________ Zip: ____________________________

Phone: _____________________ Email: ____________________________

Your Grade: ____________ School Name: ____________________________

Teacher’s Name: ________________________________________________

Please fill out the form below and submit (MAIL OR FAX) to receive your two (2) FREEtickets to the game of your choice from the list provided. All students: be sure to submit a copy of your report card or test with this form.

GOOD GRADES HAVE THEIR REWARDS

CONGRATULATIONS!

1.800.882.ISLES EXT. 4 NEWYORKISLANDERS.COM/@SCHOOL

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