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Me & my Wing
Joined: Oct 2007 Gender: Male  Posts: 392 Location: Eureka Springs, Ar. Karma: 57 |  | 2010 "STO" REGISTRATION FORM - TBA « Thread Started on Oct 30, 2007, 10:43pm » | |
THIRD ANNUAL - SCOOTING THE OZARKS RALLY! 2010-REGISTRATION FORM September 15, 16, 17 and 18 - 2010 Host City of Eureka Springs, AR . You're gonna love this place! Scooting Heaven! Host Hotel - Traveler's Inn Discounted rooms and camping now available! Make your reservations early! Wanderlust Campground http://www.roadcamping.com/rv/Arkansas/Eureka_Springs/property_3877/rv_parks_campgrounds.html NOTE* REGISTRATION IS PRORATED Pre-Register from JANUARY 1, 2010 - JANUARY 31st 2009 @ $35.00 per person Pre-Register from FEBRUARY 1 - MARCH 1- @ $40.00 per person Pre-Register from MARCH 2 - APRIL 30 - @ $45.00 per person Pre-Register from MAY 1 - JUNE 30 - @ $50.00 per person Late Registration from JULY 1 - SEPTEMBER 4 -@ $55.00 per person Registration at the Rally DAY 1 - 4 @ $65.00 per person
PLEASE PRINT THE ATTACHED FORM IN LANDSCAPE MODE ON YOUR PRINTER!!!!! PLEASE SEND THE AMOUNT INDICATED FOR YOUR PRE-REGISTRATION DATE (POST MARKS WILL BE CHECKED)
Make checks out to: Scooting The Ozarks Rally or "STO" (CHECKS ONLY)
T SHIRTS ARE ONLY AVAILABLE THROUGH OUR "STO" CAFE PRESS STORE ON THIS WEBSITE
Mail this signed form to: STO, C/O Lou Larson, 904 S 21st Pl, Wausau, WI 54401
_______________________________<cut here>_________________________________
Please Print Legibly
Name ______________________________Name _____________________________
Street _________________________ City_____________________ Zip _____
Home Phone: ( ____) ____________ Cell Number (____) ______________________
EMAIL ADDRESS ____________________________
BBQ Yes ___ No___# attending __ Pizza Night Yes __ No ___# attending ____
Emergency Contact Number (____) ______ Contact _________________________
Personal BIKE/SCOOTER insurance carrier___________________________________________________________
Policy Number___________________________________________________________
I/we agree, understand and acknowledge that operating a Maxi Scooter, Scooter, Moped, Motorcycle, Sport Bike, Cruiser, Purpose built Trike, a Scooter or Motorcycle with an add on Trike wheels, or a Scooter or Motorcycle with a sidecar can be dangerous and can result in injury or death in the event of an accident. By signing below I/we freely & willingly accept and acknowledge all risks, liabilities and responsibilities while traveling to and from STO, while participating in STO group rides or STO events and while traveling privately on my/our own before, during, and after STO. Further I/we agree to hold harmless the STO organizers and volunteers of any wrong doing in the event of my having an accident, injury or any financial hardship before during and after the STO rally. I also certify that I am licensed to operate a motorcycle in my home state (if required).
Signature _____________________________ Signature ________________________
Date of registration ____/____/ 2009 TOTAL ENCLOSED $______ (STAFF USE ONLY)
TOTAL RECEIVED $______ TOTAL DUE $ ______ DATE RECEIVED____/____/10
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