Start Date: 2024-05-06       Departure Date: 2024-05-11

Anchors Aweigh RV Park

• Address: 19814 County Rd 20 S, Foley, AL 36535
• Phone: (251) 971-6644
• For Reservations Contact: Campground

Sponsor(s): MS Magnolias and White Sands Panhandlers

Host: Charley LeBlanc     Phone: (504) 616-6959     Email: chasndianne@bellsouth.net

Muster Costs:

Single Cost: $15.00   Couple Cost: $30.00   Couple + Guest Cost: $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 $15.00.00   Two Persons $30.00.00   Two plus Guest $45.00.00

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

Tours

  Tour#1 Fun Boat Dolphin Cruise Cost is per p - Cost: $28.60

Boat trip out of Dolphin Island Monday May 8 carpooling, leaving at 1330.The tour is from 1430 to 1630. Payment to Joan Scheet, 11150 SW 71st Ct, Ocala, FL 34476 no latter than April 20.   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 Charley Leblanc), to Charley LeBlanc, 120 Mossy Oaks Dr, Slidell, LA 70458.