Nebraska Good Sam Rally on-line registration.

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Email:*

First Name*

Last Name*

2nd Person First Name

2nd Person Last Name

Street*

City*

State*

AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

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Telephone #

Registration for 1 Rig 2 people $85.00*

1 0

Registration for 1 Rig 1 Person $80.00*

0 1

Registration $40.00 per additional adult

0 1 2

Catered Meal Saturday Night $14.00 per person

0 1 2 3 4

Do you need handicapped parking?

N Y

Is this your first Nebraska Rally*

N Y

Is this your first Rally anywhere*

N Y

Please select Nebraska chapter you are a member of

None Blue River Sams Capitol Sams Elkhorn Valley Sams Flat Rock Campers Lodgepole Valley Sams Logan Valley Sams Loup Valley Sams Mid Nebraska Sams Nebraska Chapter at Large Nebraska Veteran Sams Pathfinder Sams Sandhill Campers Second Chance Sams Swingin Sams Wagon Wheel Sams

OnLine

The undersigned accept full responsibility for the welfare of their unit and persons with their unit while attending the Nebraska Good Sam Rally*

Y N

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