REGISTRATION

Show Dates JULY 28 & 29, 2012

Pre- Registration of $20.00 in due by July 26, 2012

1 Day  Attendee's are welcome $15.00 pre-registered or at the gate

After July 27 or at the event registration is $30.00 for the 2 day show

SORRY NO REFUNDS AFTER JULY 27

MAIL TO:

Packwood Summer Rod Run

P. O. Box 228, Packwood, Wa. 98361

REGISTRATION FORM:

{  } 1 Day -$15.00     {    } 2 Day - $20.00 Pre-registration    {   } Ladies Ride - owner/operator            

  Amount Enclosed $ ____________________

Name _______________________________________ 

Address ____________________________________

City ___________________  State __________________ Zip __________________

Phone Number ____________________    E-mail ___________________________

VEHICLE INFO:

Year ___________ Make/Model __________________________ Color _____________

I _________________ Release East End Cruisers, Jim & Patti Peters and the Cowlitz River Lodge from any

LIABILITIES occurring to myself or any person and/or vehicles while attending this event.

SIGNATURE OF ATTENDEE __________________________ DATE ____________________

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