Rally@Potomac 2002

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RALLY @ POTOMAC REGISTRATION FORM

There are two ways to register:

1. Fill out the registration form, print it and mail it to the address below with your registration fee.
2. Fill out the registration form, print it, press submit, and then mail it to the address below with your registration fee.

Either way you register, you will need to print the form and send it with your registration fee. We would like for everyone to register online so that we receive your information as soon as possible. You will receive an e-mail verification of receipt of your online registration and your registration fee. Please put your e-mail address on your check.

Registration Fee: Participant: $50.00 Non-participant (Meals only) Price to be decided

THE REGISTRATION FORM IS FOR ONE PARTICIPANT ONLY!!!
EACH PARTICIPANT WILL NEED TO FILL OUT A REGISTRATION FORM!!

Participants must be 16 years of age by June 15, 2002.
(Signed parental consent will be required for participants under 18).

Mail Registration Forms and Fees to:

Jim Funkhouser
Rally@Potomac
8117 Ainsworth Ave.
Springfield, VA 22152

Registration fee must be paid either by check or money order. DO NOT SEND CASH!!
Checks must be made payable to: Jim Funkhouser

Registration forms and Entry fee must be received no later than May 15, 2002, in order to derive full benefits.

CONTACT INFORMATION

Name:
Handle:
E-mail Address
Street Address
City
State
Zip
Home Phone

LODGING INFORMATION:

Do you need additional lodging information or assistance? Yes No

Location where you will be staying (Include Room #)

Indicate Estimated Arrival Date and Time

BOAT INFORMATION:

ALL BOATS MUST BE AT LEAST 15 FEET LONG, HAVE A FUNCTIONING LIVEWELL, AND CARRY A CURRENT LIABILITY INSURANCE POLICY IN THE AMOUNT OF AT LEAST $100,000 IN ORDER TO PARTICIPATE.

Will you be bringing a boat? Yes No

Will you participate in the Partner Draw or fish with your spouse, minor child or significant other? Draw Other

Will you be bringing Non-participants? Yes No

If Yes, how many?

Will they want meals? Yes No

SHARE A RIDE/EXPENSES

Would you like for your contact information to be made available to those wanting to share the ride/other expenses? Yes No

QUESTIONS AND COMMENTS

Please add any questions and/or comments that you may have.