Gold Wing Road Riders Association

The Maryland District

Maryland Winterthing Registration Form

Rider ____________________________________________________ ______________

GWRRA Member # ___________________________________EXP: __________________

Co-Rider ________________________________________________ _______________

GWRRA Member # ___________________________________EXP __ ________________

Address________________________________________________ _________________

City ______________________ State ______________ Zip _ __________________

Phone ( ) ________________ Chapter _________Email ___ ___________________

GWRRA staff position _______________________________ 
Registration FEE

Member or Associate Member       $30.00 x __________ = $__________
Non-Member                                     $35.00 x __________ = $__________
Children (under 12 with meal)         $15.00 x __________ = $__________
After 1/l/01 add late fee                    $ 5.00 x __________ = $__________

                                                                         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 ___________
Please Check here if arriving for Thursday Night Special  __________
Direct Mileage to Winterthing __________________
Make check payable to: "GWRRA Maryland"
Mail to: GWRRA Md District Treasure
         204 D Victor Pkwy
                  Annapolis, MD.21430

Additional Information Contact: Tommy & Ruthie Chedester 301-373-2781 chedester@radix.net