Name :     Call:

Number of Adults: @ $30 per 

Number Of Children 12 and Under: @ $15 per

Names and callsigns of those attending as you want it to appear on your name badge:

Day Phone:      Night Time Phone:

Email:

Date Arriving:   mm/dd/yyyy 

Date Leaving:   mm/dd/yyyy

RV Staying On Carnival Grounds:   Yes or No 

Number Of Nights:

Participating In Antenna Shootout ?   Yes or No

Which Hotel/Motel Are You Staying At?

How Many Nights?

Attending Breakfast Sunday Morning? Yes or No 

How Many? @ $5 per

Interested In buying Eyeball T-Shirt:   Yes or No (TBD depending on Interest)

Payment Form: (Paypal, Check, Money Order) If paying by Check or Money Order Make check out to BILL DOBSON, please send form in with payment. If paying by Paypal please mail in form to complete registration. Paypal payment should be sent to n3wd@arrl.net Please add $2.50 to cover Paypal Charges.

No of Extra Chance Door Prize Tickets: $1 a piece or 6 for $5

Amount Sent: Adults $30 per person registration, Children 12 and Under $15 per, Sunday Breakfast @ $5 per, Extra Chance Tickets @ 1 for $1 or 6 for $5 (you get one ticket per registrant).

Bringing Door Prize Please fill out below what you are bringing: