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 __________ = $__________

                                                         Registration Fee Enclosed $___________


Shirt Order Form

                 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 Golf Shirt                 $17.00 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)  

                                  Shirt Order Enclosed $___________

                               
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