
ICE CREAM SOCIAL (THURSDAY EVENING)

GRAND PRIZE

RALLY PIN (1st 300 FULLY REGISTERED)

REGION COUPLE OF THE YEAR SELECTION (INCLUDES ALL COUPLES
APPALACHIAN REGION N
FALL FINALE
PRESENTS
A BUCCANEER’S BASH
“MEET & GREET”)

VENDORS

2 GUIDED RIDES

MASTERS BREAKFAST

UNIVERSITY TRAINING SEMINARS

HOSPITALITY ROOM (WITH THEMED BAKING CONTEST)

STATISTICAL AWARDS

EARLY BIRD DRAWING (REGISTRATION MUST BE RECEIVED BY
SEPT. 15, 2017 TO BE ENTERED IN THE DRAWING)

WINGO

50/25/25 (DAILY & GRAND)

COUPLE OF THE YEAR BASKETS

RALLY THEMED COSTUME COMPETITION (USE YOUR IMAGINATION)

ENTERTAINMENT (ROSALEE & WILLIE BOYLES WILL BE BACK WITH
THEIR SHOW - FULL OF FUN AND SURPRISES. DON’T MISS THIS.)

BUFFET DINNER
SEND CHECK OR MONEY ORDER PAYABLE TO : GWRRA - REGION “N”
(Please do not send cash.)
MAIL ENTIRE PAGE WITH CHECK TO:
Glenda & Alan Keough
5100 Garner Lane
Southaven, MS 38672
Located at the Holiday Inn and Convention Center
101 W. Springbrook Drive
Johnson City, Tennessee 37604
(423) 282-4611
Mention GWRRA for $74.00/night rate
Registration
2017 FALL FINALE SHIRTS:
PLEASE PRINT CLEARLY
Rider______________________________________________
Chapter_____ State _______ Age_____
GWRRA #____________ Exp Date_________
SHORT SLEEVE T-SHIRT
S,M,L,XL - $14 / 2XL, 3XL - $16
LONG SLEEVE T-SHIRT
S,M,L,XL - $17 / 2XL,3XL - $19
______
_____ _____ __________
#
Position:____________________________
______
#
Int’l____ Region____ District____ Chapter____
Co-Rider___________________________________________
______ __________
SIZE
AMOUNT
______ __________
SIZE
Chapter_____ State _______ Age_____
GWRRA #____________ Exp Date_________
______
Position:____________________________
______
Int’l____ Region____ District____ Chapter____
#
Address___________________________________________
City,State,Zip_______________________________________
SIZE
AMOUNT
_____ _____ __________
AMOUNT
SHORT SLEEVE GOLF SHIRT
S,M,L,XL - $21 / 2XL,3XL - $23
#
#
#
SIZE
AMOUNT
______ __________
SIZE
AMOUNT
______ __________
SIZE
AMOUNT
GRAND PRIZE OF $1,000.00 CASH
Phone: Home_______________ Cell_______________
Each FULL registration (both pre-registration and on-site) will include ONE grand prize
ticket.
Email_____________________________________________
Additional Grand Prize Tickets - $5 each or 5 for $20
Distance traveled to Rally (straight-line mileage/one way)_____
# of tickets _____x$5 = $__________
Motorcycle (2 wheels) ___ Motorcycle (3 wheels) ___ Car___
GWRRA Member
Non-Member
Pre-Registered
After October 1st
Pre-Registered
After October 1st
13—15 years old
12 & Under FREE
Masters Breakfast (Pre-Registration Only)
Buffet Dinner (Pre-Registration Only)
Shirts
Grand Prize Tickets
Grand 50/25/25 Tickets
Total
$30 x ___ =
$35 x ___ =
$35 x ___ =
$40 x ___ =
$10 x ___ =
$_______
$_______
$_______
$_______
$_______
$10 x ___ = $_______
$20 x ___ = $_______
= $_______
= $_______
= $_______
= $_______
# of 5 packs_____x$20 = $__________
GRAND 50/25/25 TICKETS
Pre-purchase your Grand 50/25/25 tickets. Drawing will be held Saturday during
closing ceremonies. MUST BE PRESENT TO WIN.
1 yard of tickets for $10 = $__________
3 yards of tickets for $20 = __________
RELEASE FORM (Must be signed by all registrants)
I/We agree to hold harmless GWRRA, Region N including all districts therein, the Holiday Inn of
Johnson City, and any property owners for any loss or injury to self or property by reason of participating in this event.
Rider Signature_____________________________________________________ Date ________
Co-Rider Signature__________________________________________________