Online Registration for CA1R's Rally in the Valley 2009

Rider Name: 

Rider GWRRA #:  
Co-Rider:  
Co-Rider GWRRA #:  
GWRRA Chapter/Club:  
Address:  
City:  
State:  
Zip:  
Phone:  
E-Mail:  

Early Registration Fees Paid by March 6, 2009
GWRRA Member: x $18.00 = $ Total  
Non-Member: x $20.00 = $ Total

Total Registration $

T-Shirts Sold by Pre-Order/Pre-Paid Only by March 6, 2009
Small: x $19.00 = $  
Medium: x $19.00 = $  
Large: x $19.00 = $  
X-Large: x $19.00 = $  
XX-Large: x $20.00 = $  
XXX-Large: x $20.00 = $

Total T-Shirts:$

50/25/25:  Indicate the tickets you want by clicking the appropriate option button.
 Unless you specify a greater number, you'll get one (1) set of tickets for your selection.

If you Pre-Pay by March 6, 2009, you'll receive the amount in ( )
Drawing Saturday night at the Casa Blanca Hotel
(General admittance at 7:00 pm for those not attending the banquet)
Raffle Tickets
10 (15) Tickets for $5.00
 #sets		 65 (85) Tickets for $20.00
 #sets		  
25 (35) Tickets for $10.00
  #sets		 110 (140) Tickets for $30.00
 #sets

Total Tickets $
   
Optional:  Saturday Evening Buffet (Advance Tickets Required)
Casa Blanca Hotel, 6:00 PM - Price includes tax and tip
  x $26.00 each  (If you're not eating dinner, please enter "0")

Total Dinners $
   

Grand Total $

By the electronic submission of this form, the above named individuals agree to comply with the ideals governing this event and to hold harmless the GWRRA co-sponsoring organizations and property owners for any loss or injury to self or property in which I/We may become involved and I/We agree to assume responsibility for any property which I/We knowingly damage.

Please note that payment information and a mailing address are on the confirmation page!