Desert Dash Rally Registration Form

August 20, 21, 22 2010

www.hcdesertdashrally.com

Complete the registration form and return to the address below

Registration is $35 per person

Submit mailed registrations to: Desert Dash Rally P.O. Box 907 Hines, Oregon 97738

Phone: (541) 729-4233

Registration to the Desert Dash Rally includes:

· Run T-shirt & Run Pin (1st 250)

· Admission to all live music events at the Park

· Entry in any all field events/games

· Poker run hand ($400 purse)

Name:_____________________________Email:_____________________________

Address:______________________________________________________________

City:_________________________State:___________________ Zip:_____________

Phone (____)_______________

T-Shirt size: circle one       S       M      L        XL        XXL       XXXL

Name:_____________________________Email:_____________________________

Address:______________________________________________________________

City:_________________________State:___________________ Zip:_____________

Phone (____)_______________

T-Shirt size: circle one S M L XL XXL XXXL

Vehicle Information

Make:

Year:

Model:

Color:

· Pre-registration _________ _____________________________@ $35.00.......................$______

· Additional T-shirts @ $18.00 for S-M-L-XL……............................#_________size........$______

· 2XL & 3XL @ $20.00...............................................................#__________size..............$______

· Tank Top @ $15.00 for S-M-L-XL(limited quantities available please preorder)#____size.$____

· 2XL & 3XL @$18.00 (limited quantities available please preorder ...#_______size………..$____

· Additional run pins @ $5.00.........................................................#_________pins...........$______

· Additional Poker Hand @ $10.00......................................................................................$______

· Saturday Night Dinner $15.00 pp..................................#_________ dinners...................$______

· Total due with registration.......................................................................................Total $______