Rivershiver 2010 Registration

* indicates a required field

Personal Information
Name: *
Address: *

City: *
State/Province: *
Zip/Postal: *
Phone: *
E-mail: *
TLCA Membership #:
Any special diet concerns (e.g. food allergies, vegetarian, etc):
Any Medical Conditions we should be aware of:
Emergency Contact information: *
	Check here if you'd like to help with the event
Vehicle Information
Year of Vehicle: *
Type of Vehicle: *
License Plate: *
Tire Size:
Winch?:	Yes No
Skill Level: *
# of Passengers: *
Payment Information
Early Bird registration = $225.00 CAD for vehicle and first person and is due by December 31, 2009. Regular registration = $275.00 CAD for vehicle and first person and the final registration deadline is January 31, 2010. A registration includes one grab-bag of event goodies. Each Additional passenger in a vehicle will cost $125. Refunds: If you get accepted but cannot make it, no problem. Please note that there is a $5.00 refund fee. Refunds will be mailed after event date. No refunds granted if requested after January 31, 2010.
Please select a Payment Option: *