Maryland / Delaware District Rally Registration Form
Rider
_______________________________________________________________________________________________
GWRRA Member # _______________________________________________________EXP:
__________________________
Co-Rider
____________________________________________________________________________________________
GWRRA Member # ________________________________________________________EXP
__________________________
Address______________________________________________________________________________________________
City ___________________________________________ State ______________ Zip
___________________________
Phone ( ) ________________________ Chapter
_______________________________________________________
GWRRA Officer position (If
applicable:_______________________________________________________________
Registration FEE
Member, Associate, Booster
$32.00 x __________
= $__________
Non-Member
$37.00 x __________ = $__________
Children (under 12 with meal)
$15.00 x __________ = $__________
After 5/01/00 add late fee
$ 5.00 x
__________ = $__________
Day
Pass
$10.00 x
__________ = $__________
Day Pass with Bike show entry
$15.00 x
__________ = $__________
Total Rally Registration: $___________
Rally Merchandise
Ral1y T Shirt
$12.00 x __________ = $__________
Smal1 _____ Medium _____ Large _____ X Large ______
XX Large _____ XXX Large (add $2.50 each)
$__________
Long Sleeve T Shirt
$14.00 x
__________ = $__________
Smal1 _____ Medium _____ Large _____ X Large ______
XX Large _____ XXX Large (add $2.50 each)
$__________
Ral1y Sweat Shirt
$20.00 x __________ = $__________
Smal1 _____ Medium _____ Large _____ X Large ______
XX Large _____ XXX Large _____ (add $2.50 each)
$__________
Ral1y Golf Shirt
$17.00 x __________ = $__________
Smal1 _____ Medium _____ Large _____ X Large ______
XX Large _____ XXX Large _____ (add $2.50
each)
$__________
(No Pre-Order for shirts will be accepted after 5/01/00)
Total Merchandise $__________
Grand Total Enclosed $__________
I/We, the undersigned agree to and will
comply with the rules of this event. I/We further agree to hold harmless the GWRRA, its
officers and representatives or persons sponsoring this event for loss or injury to myself
or property in which I/We may become involved by reasons of participating in this event.
I/We the parents understand and agree we are responsible for our children. I have read and
understand this form.
Rider Signature ______________________________________________ Date
_________________
Co-Rider Signature ___________________________________________ Date
_________________
Make check payable to: "GWRRA Maryland"
Mail to:GWRRA Maryland
5106 Baltimore Avenue
Bethesda, MD 20816