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SOUTHERN CRUISERS RIDING CLUB WV STATE RALLY 2023

Fairmont WV - JUNE 8-11 2023
Name*

First NameLast Name
RALLY REGISTRATION SHIRT SIZE select only one per registration please*

SMALLMedLARGE1X2XX3XXX4XXXX
Chapter Name & Number
E-mail*
example@example.com
Emergency Phone number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My Products
prevnext( X )
Registration$35.00

extra shirt SMALL$15.00

extra shirt LARGE$15.00

extra shirt MED$15.00

extra shirt 1X$15.00

extra shirt 2XX$15.00

extra shirt 3XXX$15.00

extra shirt 4XXXX$15.00

Total $0.00
FOR PAYMENT BY MAIL:

PLEASE PRINT FORM AND SEND COPY WITH YOUR PAYMENT - PLEASE DO NOT SEND CASH THROUGH THE MAIL - DO NOT USE SUBMIT BUTTON -

MAKE CHECK TO: WV STATE RALLY

MAIL TO:

1517 Clearview Heights. charleston, WV 25312

CREDIT CARD - PAYPAL - USE SUBMIT BUTTON

Pay with Credit Card

SOUTHERN CRUISERS RIDING CLUB WV STATE RALLY 2023