| Rocket Roundup 2016 Registration
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| Last Name: |
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City: |
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First Name: |
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Province: |
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Address: |
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Postal Code: |
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Membership ID: |
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Email: |
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Please enter quantities for the items you wish to order,
and calculate the totals.
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| *** If you are not paying through PayPal,
please download the printed
form and mail in with payment. |
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| Vehicles: (Member
Pricing - 1st Car $10.00, additional cars $5.00 each. Non-Members
pay $20.00 for 1st vehicle, additional cars $10.00 each) |
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| Note: You can purchase a membership
at the bottom of this form. |
Quantity |
Price |
Total |
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| 1. Year:
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Model:
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Member Price:
before July 9, 2016 |
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| Body Style:
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Member Price:
After
July 9, 2016 and
Non-Member Price: |
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| 2. Year:
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Model:
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Member Price: |
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| Body Style:
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Non-Member Price: |
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| Banquet Choice: |
(must know by
July 9, 2016) |
Chicken |
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Beef |
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| Northern Lights 25th Anniversary
T-Shirt: |
Small |
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Medium |
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Large |
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Extra Large |
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| Northern Lights
20th Anniversary Car Flag: |
(while quantities last
no re-order) |
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| Northern Lights
25th Anniversary Car Flag |
(limited quantities
no re-order) |
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Northern Lights Chapter Membership
(Expires January 31, 2018):
(NEW MEMBERS ONLY - STARTING IN JULY) |
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| ** Ensure this Total is correct,
then click submit to pay ** |
Total |
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** Your
transaction can not be completed until payment is made! **
If you are not paying through Pay Pal, please download the printed
form and mail in with payment.
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