Rally Region H

Region H 2009 Rally
On-Line Registration

Registration Information - Children under 12 FREE
Full Registration - includes all days and all events - Enter qty of tickets wanted
GWRRA Member Qty:	(Number)	$25.00
Life Member Qty:	(Number)	$12.50
Non Member Qty:	(Number)	$30.00
Day Passes - Includes all events on the day of use - Enter qty of tickets wanted
GWRRA Member Qty:	(Number)	$15.00
Non Member Qty:	(Number)	$18.00
	Total:
Rider Information
First:
Last:
GWRRA Member No:
Exp Date:
Age:
Birthday:
Co-rider Information
First:
Last:
GWRRA Member No:
Exp date:
Age:
Birthday:
Rider Address
Address:
Apt:
City:
State:
Zip:	(US ZIP Code (5 digits))
Phone:	(Phone Number)
Email:	(E-mail)
Rider Affiliation
Region:	Letter
District:	2 Letter Abbreviation
Chapter:	Letter or Letter Number
Direct Mileage to Rally:	(Number)
I/We agree to hold harmless GWRRA, any co-sponsoring organizations, and any property owners for any loss or injury to self or property by reason of participating in this Rally. I/We also agree to assume responsibility for any property which I/We knowingly damage.
Rider:
Co-rider:
To provide each member with a more enjoyable experience at the Region H Rally, we are gathering some preliminary participation information from the members. For more information on the competitions please see the August 2005 Region H newsletter. I/We plan on competing in the following events:
Bike show:
Class:	Choose one
Size:
Dress Competition:
Group theme:
Individual theme:
Chapter shirt:
Chapter riding:
Chapter parade:
Couple riding:
Couple parade:
On-bike Games:
Off-bike Games:
Kid's Games:
Light Show / Parade:
Talent Show - Comedy:
Talent Show - Serious:
Poker Run:
Registration Date:	2009-1-7
	Total Registration:

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Region H 2009 Rally On-Line Registration

Total:

Total Registration:

Region H 2009 Rally
On-Line Registration