Start Date: 2025-09-15       Departure Date: 2025-09-20

Mineola Civic Center

• Address: 1150 N. Newsom, Mineola, TX 75773
• Phone: (903) 569-6115
• Website: https://mccrvpark.com/
• For Reservations Contact: HQ

Sponsor(s): Midwest Region

Host: Richard Palmer     Phone: (210) 218-6838     Email: richpal1@swbell.net

Muster Costs:

Single Cost: $140.00   Couple Cost: $250.00   Couple + Guest Cost: $360.00   Camping/night: $45.00  

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

In Case of Emergency (ICE) Contact Information

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

Notify:   Phone:   Relationship:

Notify:   Phone:   Relationship:

RV Information

RV Type:         Make:

Model:         Length:

I tow a vehicle behind my motor home.   Total length of tow and towing vehicles:

Attendees:   One Person $140.00.00   Two Persons $250.00.00   Two plus Guest $360.00.00

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

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

Planned Arrival:       Planned Departure:

Camping Costs: $   45.00/night

Luncheons Are you attending the luncheons?

Mens Luncheon:         Ladies Luncheon:         Lunch Total: $

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

Shirts (S-XL) $28.00 each. Shirts (XXL-4XL) $28.00 each.

Mens Qty:   Size: (Mens Small to Mens 4X)

Ladies Qty:   Size: (Ladies Small to Ladies 4X)

Shirt 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.

Total Submitted: $_____________________

Please mail a copy of this form along with your check, (payable to SMART), to .