2014 Capital District Fall Rally Individual & Team Registration Form

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First Name: *

Last Name: *

Address: *

City: *

State: *

Postal Code: *

Phone Number: *

(XXX-XXX-XXXX)

Email Address *

Key Club of

(If applicable)

Registration Selections: *

(Please check the box that applies to you)

Regular Attendee - $35.00 (Park Admission)

Park Season Pass Holder - $5.00 (Includes an Eliminate pin)

Required

For GROUP registrations: How many people are you bringing?

Multiply $35.00 by the number of participants

Will you like a Meal Ticket for $15.00? *

Good at the Kings Dominion establishments

Yes

How many Meal Tickets?

Total amount to be sent via mail: *

Please mail all checks postmarked by the deadline of OCTOBER 11 to Joe Stankus and write your FULL name in the Memo sections. Capital District Key Club Administrator 1229 Bellevue Avenue Richmond, Virginia 23227 (Please make all checks payable to Capital District Key Club. All registrations are final and binding.) *

Yes, I understand filling out this form does not complete my registration, and that I must mail my payment according to the directions above.

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