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