REGISTRATION FORM - BIG HUMP 2006 GREEN DRESS RUN



Or click here for a mail in rego

Hash Name:
Home Hash:
  
Nerd Name:
Address:
City:
State:
ZIP:
  
Phone: (123-123-1234)
E-mail:
  
please check one Do you want us to put your E-mail address on the who's coming web page?
YES
NO!!!
   
please check one  
  
I want it all! ($75.00) What a deal!!!
I am cheap. ($35.00) Saturday's run and the on-after only. (NO GIVEAWAYS)
  
Jacket Size:
M
L
 		XL
 		XXL
  
please check one To pay by credit card follow the paypal link & then click on the button that says "I don't have a PayPal account" It will then give you the option to enter a credit card.
I'd like to pay using my major credit card (no PayPal account required!).
I'll need instructions for mailing a check.
I already gave/sent a check.
  
please check one  
Vegetarian
Give me MEAT!
  
CUSTOMARY DISCLAIMER

I hereby release the Hash House Harriers from any responsibility for any injury, death, debt, pregnancy, or any other misfortune which may befall me related in any way to my participation in this event. In other words, if I get hurt, it's my own stupid fault.

By checking this box, I signify that I have read, understand, and agree to the "Customary Disclaimer" above.