2009 Mardi Gras Madness Rally
                                         Registration Form

This Information does NOT leave your computer! This form must be printed and mailed.
Riders Name:
GWRRA #:  D.O.B.: Information For Prizes
Passenger Name: 
GWRRA #:  D.O.B.: Information For Prizes
Address: 
City:  State:  Zip: 
Phone #:     GWRRA Chapter: 

Qty Select Description Price Total 
GWRRA Member (Before March 15, 2009)  $25 
GWRRA Member ( On Site ) $30 
GWRRA Lifetime Member  $18 
NON Member ( Before March 15, 2009) $30 
NON Member ( On Site ) $35 
per 20 50/25/25 Tickets-20 For $10.00 **  $10 
per 10 Grand Prize Tickets **(Must Be Present To Win) $10 
Each Level IV Breakfast $5
per 10 Deal Or No Deal (Be A Contestant To Win $500) $10 
  Refunds Subject To 10% Service Charge. GRAND TOTAL:
Direct Miles to Rally Site    ** Saturday Night Drawing
I/We agree to hold harmless the GWRRA, co-sponsoring organization, and any property owners for any loss or
injury to self or property to which I/We may become involved by reason of participation in this convention.
Signature :    Date : 
Signature :    Date : 
Email: 
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FORM INSTRUCTIONS:                            
1) Fill out this form online                                                                    
2) Print this form
3) Make Check, Money Order payable to: GWRRA Louisiana
4) Mail to: Brent & Roxie Comeaux
                   203 Durham Drive
                    Lafayette, Louisiana 70508
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