SCRC Kentucky State Rally

Southern Cruisers Riding Club KENTUCKY STATE RALLY Lexington, Kentucky June 11-13, 2004 REGISTRATION FORM

(ONE FORM PER PERSON PLEASE)

Pre-registration for the 2004 Kentucky State Rally is strongly encouraged by May 11 th. The on-site registration fee will be on a per event basis to be collected at on-site registration and check-in. Pre- registration of rally events will ensure the Lexington Chapter has an idea of the numbers who plan to attend and to determine the number of t-shirts and patches to order.

Last Name:______First Name:______

SCRC Chapter: ______Rider OR Passenger

Street Address: ______

City:______State:______Zip:______

Telephone:______Email:______

ALL PROCEEDS WILL GO TO ST. JUDE’S CHILDREN’S HOSPITAL; no refunds.

Rally Events & Fees (Please mark the events you plan to attend): Friday Ride - FREE Saturday SHORT Poker Run - $5/hand or $12/3 hands

Saturday LONG Poker Run - $5/hand or $12/3 hands Bike Games - FREE

Patch & T-shirt - $15.00 (to ensure you get a t-shirt and patch, please pre-register by May 11th): T-Shirt Size: S M L XL 2XL 3XL 4XL

Fees for the following events will be taken at the time of the actual event, not at the registration table. Bikini Bike Wash - $5.00 Bike Show - $5.00 Tattoo Contest - $2.00

Please either e-mail form to: [email protected] OR Snail mail form to: Scott Lawson 117 Stanley Lane Nicholasville, Kentucky 40356

Please keep a copy of this form for your records, thank you.