AMERICAN TRIKE ASSOCIATION

ATA Registration 2012

PRE-REGISTRATION

ATA Rally Dates Aug. 2, 2012 Aug. 4, 2012

DEADLINE IS

Buffalo, Wyoming Indian Campground

JULY 1, 2012

PRE-REGISTRATION INFO REQUIRED PER ATTENDEE: MEMBER #__________

 

NAME______________________________________________________________

ADDRESS__________________________________________________________

CITY,STATE ZIP_____________________________________________________

 

PHONE____________________________________________________________

ATA Secretary:

EMAIL_____________________________________________________________

Ruth Martin

EMERGENCY INFO: (MEDICAL DECISION MAKER IN CASE OF EMERGENCY)

418 East Bennett Way

NAME______________________________________________________________

Buffalo, WY 82834

ADDRESS__________________________________________________________

 e-mail:

ruth-m@bresnan.net

PHONE____________________________________________________________

Phone: 307-217-3126

SECONDARY CONTACT NAME________________________________________

ADDRESS__________________________________________________________

 

PHONE____________________________________________________________

Special Medical Information (Allergies, Etc)________________________________

 

Additional Contacts

 

REGISTRATION FEES

 

 

Kindy Parker, President

 

Members

 

Non-Members

715.896.1003

 

 

 

 

New Membership

$12

 

 

Jeff Olson, Vice President

 

 

307.202.1969

 

Renewal Membership

$12

 

 

 

 

 

 

 

Rally Fee

$7

 

 

Rally Fee

$12

 

 

 

 

 

 

Indian Campground Registration

Banquet

 

 

Banquet

 

(307) 684-9601

 

 

 

 

email: indianc@trip.com

 

Cookout

Free

 

 

Cookout

$7

 

 

 

 

 

 

Buffalo Chamber of Commerce

Poker Run -Per Hand

$5

 

 

Poker Run

$7

 

(800) 227-5122

 

 

email:

 

buffalochamber@wyoming.com

Trike Games Included in Rally Fee, Please Circle the Appropriate Items:

 

 

I will be Participating in Trike Games YES / NO PASSENGER / DRIVER