| Hash Name: |
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| Home Hash: | |
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| Nerd Name: | |
| Address: |
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| City: |
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| State: |
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| ZIP: | |
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| Phone: |
(123-123-1234) |
| E-mail: | |
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| please check one |
Do you want us to put your Hash Name, Home Hash and E-Mail on the who's coming page? |
| YES |
| NO!!! |
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| please check one |
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I want it all! ($69.00) What a deal!!! |
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Friday Night Social Only. ($30.00) (NO GIVEAWAYS) |
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Saturday's run and the on-after only. I am cheap. ($50.00) |
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| Shirt Size: |
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| 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. (Note: there will be a small processing fee charged by PayPal) |
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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. |
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| please check one |
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| Vegetarian |
| Give me MEAT! |
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| please check one |
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| Staying at the Hotel |
| Staying Elsewhere |
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BEER PREFERENCE
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| please check one |
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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.
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| By checking this box, I signify that I have read, understand, and agree to the "Customary Disclaimer" above. |
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