June 26 through June 28, 2009

Hosted by Lady Knights

LAST NAME:

FIRST NAME:

ADDRESS:

ADDRESS 2:

APT:

CITY:

STATE:

ZIP:

PHONE:

EMAIL:

CLUB NAME:

CLUB CITY:

CLUB STATE:

CLUB POSITION:

MOTORCYCLE MAKE:

MOTORCYCLE MODEL:

ARE YOU STAYING AT THE HOST HOTEL?

ARE YOU BRINGING YOUR MOTORCYCLE?

HOW MANY FSBWs  HAVE YOU ATTENDED?

WHAT IS YOU SHIRT SIZE?

EMERGENCY CONTACT:

EMERGENCY CONTACT #:

Please read the waiver of liability

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YES

NO

YES

NO

I HAVE READ AND AGREE TO THE WIAVER OF LIABILITY FOR THIS EVENT