Page 10 - Travelore Issue 43 Fall 2018

Page 10 - DRVC Travelore
DRVC’s Rally at the Brickyard • March 3-9, 2019
Americus KOA • Americus, Georgia
Please print or type the appropriate information in the spaces below.
Determine your rally fee, complete the form, then send it with the correct payment due prior to February 1, 2019.
Pilot: Last Name _____________________________ First Name _____________________________
Co-pilot: Last Name _____________________________ First Name _____________________________
FMCA #: __________________ Email: ___________________________________________________________
Address: ________________________________________________________________________________________ ________________________________________________________________________________________________
City: _____________________________ State/Prov: ________________ Postal Code: _______________ Primary Phone: ____________________ Mobile Phone: ____________________
Emergency Contact: ___________________________________ Phone: ______________________
Coach Make: ________________________ Handicap Considerations: Currently DRVC Member:
First Timer:
Dietary Issues/Sensitivities: Traveling with Pets:
Model: ___________________
Length: ___________________
RALLY FEES FOR MEMBERS: Registration Type
Full Rally (Two in coach) Full Rally (One person) Each Additional Guest
• Rally Fee • $ 375.00 $ 275.00 $ 100.00
Questions or clarifications? Send an email to: treasurer@dieselrvclub.org
Arriving early or staying late? Please contact:
Americus KOA
1619 U.S. Highway 280 Americus, GA 31709 229-874-1234 koa.com/campgrounds/americus/
For the latest information, please visit www.dieselrvclub.org
Yes _________ Yes _________ Yes _________ Yes _________ Yes _________
No _________ No _________ No _________ No _________ No _________
Will you have a guest(s) attending and staying in your coach? If so, please provide their name(s) and ages.
Guest of Member Information: ______________________________________________________________________
RALLY FEES FOR NON-MEMBERS:*
* Please add $25 to above prices. Visitors attending in own motorhome
are welcome to participate but subject to a $25 surcharge; limited to one rally. Charge applied to membership fee upon joining.
TOTAL RALLY FEES Total Fee Paid
Make checks payable and mail form to:
$ _________ . ___
FMCA Diesel RV Club
3916 N Potsdam Ave, PMB#1107 Sioux Falls, SD 57104-7048
REFUND POLICY:
Registrant must notify Treasurer at least 14 days prior to start of rally to receive full refund. Notice provided later will be dependent on advance fees paid to vendors.