Name__________________________________________ Spouse/Companion_____________________________WIT#______________________ Address_______________________________________________________ TEL:__________________________________ CITY___________________________________________________ State_____________ ZIP______________________ Email Address _________________________________________ Cell Phone _________________________________ Model Year ___________________________ Length of Motor home _____________ Number of Slideouts ______ Registration fee ($125/Couple) (_____# Additional Adults X Fee______) (____#Children X fee____) First Timer ( Y N) Home State ___________________ (In order to receive any consideration on special needs, it must be noted on application) Please explain any special needs, i.e. dietary, mobility, parking or other restrictions, that would help us better serve you as you attend this rally: ______________________________________________________________________________________________________ Additional Days Parking ___________________ Special Tours _________________________________ Optional Meals ____________________________ President of a Club or chapter? _______________ LOCAL CLUB/CHAPTER INVOLVED IN: ____________________________________________________________ TOTAL AMOUNT ENCLOSED $ ____________________________ (US Funds or equivalent thereof) Make check payable to GRAND CANYON WINNIES and mail to: Jan Stafford 707 W. Alamo Dr Chandler, AZ 85225-2186