2019 Oklahoma State Rally Registration.

Cost of this Event
Rider $35.00 Passenger $30.00
Pre-Registration cutoff date: 7-22-19


Print Below Print Below
Rider Name: ________________________     Passengers Name: _____________________ 
Address: ___________________________     Address: _______________________________
City: __________________________               City: ____________________________
State: ___________ Zip Code: _________      State: ___________ Zip Code: __________
E-Mail: ____________________________       E-Mail: ________________________________
Chapter Name: ______________________     Chapter Name: _________________________
Chapter Number: ___________                       Chapter Number: ____________
                   Check One                                                            Check One
Chapter Officers: 1st ____ 2nd ____               Chapter Officers: 1st ____ 2nd ____
State Officer for what State: _____________  State Officer for what State: ______________
Asst: State Officer for what State: _________Asst: State Officer for what State: _________
National Officer Title: ___________________ National Officer Title: ____________________


Rider: $35.00 Passenger: $30.00
Pre- Registration Include:
Event T-Shirts 
Event Patch 
Extras Event T-Shirts $25.00                                                                                                
Event Patches $10.00

                                                   Registration Cost:

Rider:                                  $35.00 $ ________ T-Shirt Size _____
Passengers:                       $30.00 $ ________ T-Shirt Size _____
Extras Event T-Shirts:       $25.00 X ________ = $ ________
Extras Event Patch:           $10.00 X ________ = $ ________ 
                                            Total: = $ _________ & Check Number__________

Mail this compete Registration with a check made out to.
Leonard Space
Address: 20845 South Diana Drive.
City: Claremore State: Oklahoma Zip Code: 74019