Happy Birthday Club Form               Celebrate Your Birthday With Us!!
The Comix Cafe
"Rochester's Only Comedy Club, Restaurant & Lounge"

   Name _______________________________________

   Address _____________________________________

   City ______________   State _____   Zip ________

Birth Date ________   Phone Number ___________   E-mail __________________


Send Form To: 
Comix Cafe/Birthday Club
3450 Winton Place Plaza
Rochester, NY 14623