2023 March Madness Registration Form

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Start Date: 2023-03-02       Departure Date: 2023-03-05

Bushman's RV Park


Sponsor(s): Texans

Host: Paul Rider     Phone: (903) 574-1217     Email: afchap@gmail.com


Muster Costs:

Single Cost: $20.00   Couple Cost: $40.00   Couple + Guest Cost: $60.00  

Registration

An entry in all fields shown in the registration form is required.

Pilot:   SMART#:

Copilot:   SMART#:

   

Pilot's Email:

       

In Case of Emergency (ICE) Contact Information

Please provide at least one emergency contact other than your Copilot.

   

   

RV Information

       

       

I tow a vehicle behind my motor home.  

Attendees:   One Person $20.00.00   Two Persons $40.00.00   Two plus Guest $60.00.00

I (We) are first time attendee(s).

Guest Name:   Enter guest first and last names or “None.”

     

Handicap Parking         30 Amps   50 Amps

Do you or your traveling companion use any of the following, cane, walker, electric wheel chair, scooter, C-PAP?  

If Yes, please indicate which one(s):

Special Diet Needs  

His:  

Hers:

  I will volunteer to help at the Muster

Tours

  Tour#1 Wine/Spirits Tasting, Kiepersol Vineyard - Cost: $0.00

Wine & spirits tasting, 3pm on Friday at the Kiepersol Vineyards apx 5 miles from the RV Park ... $25 per person payable to the vineyard   Total: $

Liability Release

In consideration for my (our) attendance, I (We) hereby release and agree to indemnify and hold harmless SMART, its officers, directors, employees, agents, successors, and assigns from any and all liabilities, claims, losses, and/or damages arising from my (our) attendance at this event.

All attendees must read and sign this form.

Name Signature Date
Pilot:
Copilot:
Guest:

Total Submitted: $_____________________

Please mail a copy of this form along with your check, (payable to Smart Texans), to Nell Dahl, 5009 Barbara Rd, River Oaks, TX 76114.