Mudbug Rally Registration Form

May 15, 2010

 

 

This form must be printed and mailed.

 

Rider:         Co-Rider:   
GWRRA#: GWRRA#: 
Address:     City:   State:     Zip: 
Phone:        Chapter:  Miles To Rally: 
 

I/We agree to hold harmless GWRRA, the city of DeRidder, the American Legion, LA Chapter "M", and any property owners for any loss or injury to myself or to my property as a result of my/our participation in this event.  Further, we agree to assume responsibility for any property which I/We knowingly damage.

Rider:          _______________________

                   (signature)

Date:   ____________

 Crawfish:   ____ Brisket:  ____

Co-Rider:    _______________________

                   (signature)

Date:   ____________

 Crawfish:   ____ Brisket:  ____

 

FORM INSTRUCTIONS:

1.  Fill out this form online

2.  Print this form

3.  Make check payable to GWRRA LAM

4.  Mail to:  Sheila Brinkley

                   235 Hwy 111

                   Merryville, LA 70653