Print Use this form to print a blank form. Prints best in Chrome.
Start Date: 2024-11-30 Departure Date: 2024-12-07
CB Smith Broward County Park
Sponsor(s): Gold Coasters
Host: John Steinbauer Phone: (210) 386-9018 Email: jfs9840@gmail.com
Muster Costs:
Single Cost: $15.00 Couple Cost: $15.00 Couple + Guest Cost: $15.00
An entry in all fields shown in the registration form is required.
Pilot: SMART#:
Copilot: SMART#:
Home: Pilot's Mobile: Copilot's Mobile:
Pilot's Email:
Street
City State Zip
Please provide at least one emergency contact other than your Copilot.
Notify: Phone: Relationship:
RV Type: Make:
Model: Length:
I tow a vehicle behind my motor home. Total length of tow and towing vehicles:
Attendees: One Person $15.00.00 Two Persons $15.00.00 Two plus Guest $15.00.00
I (We) are first time attendee(s).
Guest Name: Enter guest first and last names or “None.”
Planned Arrival: Planned Departure:
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
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.