11th Annual SCRC Tennessee State Rally


*11th Annual Tennessee State Rally*

Registration Form
Proceeds Benefit St Jude Children's Research Hospital
June 3rd - June 5th, 2011
If you have problems Registering OnLine
Click Here
For a Printable Application

Rider:	Age:
Passenger:	Age:
Address:	Officer (Y/N):
City , St Zip	Position:
Telephone #:	EMail Address:
If an SCRC Member - Chapter Name:
Will you have children 18 or under:	How Many and Ages:
NOTE: Full Registration includes 1 T-Shirt, Poker Run and 1 Pin. Only click on Extra Rally T-Shirt, Extra Poker Run or Extra Rally Pin if ordering Extras.
	Cost		Qty	Extended Amount
Full Registration: Includes 1 T-Shirt, 1 Poker Run & 1 Pin	$20.00	ea		$
Extra Individual T-Shirts	$10.00	ea
Extra Poker Runs	$5.00	ea
Extra Individual Pins	$5.00	ea
Total:

Quantity of Pins and T-Shirts Available will Be Limitied!
T-Shirts (Specify Quantity)

S Qty	M Qty	L Qty	1X Qty	2X Qty	3X Qty	4X Qty	5X Qty

RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT

A Waiver must be signed at the Rally Registration Table by all Participants

To pay by check,
mail check for total amount made payable to:
"Bill McEachern" with "TNRally11" in remarks to:
William McEachern
1345 Maria St
Memphis, TN 38122

The submit registration button below will submit your registration information and forward you to the Payment Information page and Confirmation page. Please do not press your BACK button after pressing the Submit Registration Button.