AZ District Logo

Arizona District Rally

October 19-21, 2007

Tucson, Arizona

 

Checks for registration should be made out to GWRRA AZ DISTRICT and sent to:

Diane Lumpkin

9366 E. Stella Road

Tucson, AZ 85730
 

To register for the 2007 District Rally please input the information below. Thank you.



Rider's First Name Last Name GWRRA Number
Co-rider's First Name Last Name GWRRA Number
Mailing Address City
State (two letter code) Zip Code
Email Address
Region District Chapter

GWRRA Members (@ $15.00 each) Total Number
Non GWRRA Members (@ $17.00 each) Total Number
Tickets
50/25/25 Tickets (1 for $1) input the amount of single tickets you want, not the amount you want to spend Total Tickets
50/25/25 Tickets (Strip of 6 for $5) input the amount of strips you want, not the amount you want to spend. Total Strips
50/25/25 Tickets (Strip of 15 for $10) input the amount of strips you want, not the amount you want to spend. Total Strips
50/25/25 Tickets (Strip of 40 for $20) Note this is $20 for each strip, 20 strips will cost you $400, input the amount of strips you want, not the amount you want to spend. Total Strips
Grand Prize Tickets ($5 for 1) input the amount of single tickets you want, not the amount you want to spend Total Tickets

Poker Run
Hand(s) (@ $5.00 each) Total Number

Trike Course
Trike(s) (@ $10.00 each) Total Number
Course fee refundable upon completion of the course

Day Passes

Pass(es) (@ $10.00 each) Total Number

By hitting the submit button I/we agree to the Disclaimer below!

Disclaimer

I agree to hold harmless the GWRRA,  cosponsoring organizations and businesses, and property owner(s) for any loss of injury to self or property in which the entrant may become involved in by reason of participation in the event. Each entrant also agrees to assume responsibility for any property which they knowingly damage.