GOOD VIBRATIONS^®
Participant Registration Form
July 13 - 15, 2012

Please fill in all items that apply. Clicking "Register Now" will present you with a printable Registration Form for your records or to register by mail using check or credit card. By registering online using our secure server, your card will be billed for registration and optional items.

All registered vehicles must carry motorcycle liability coverage with minimum limits of $15,000/$30,000 bodily injury and $10,000 property damage or statutory limit in state of motorcycle registration.

Entrants must be at least 18 years of age.

REGISTER NOW! Please complete the following information. You are on a secure server. It is safe to pay online using your credit card.
Contact Info:
First Name:
Middle Initial:
Last Name:
Mailing Address:	Apt
City:
State:	Zip:
Email:
Home Phone:	- -
Cell Phone:	- -
Preferred method of contact:	E-Mail Work Phone Home Phone
Please tell us where you will be staying
How many nights
Cycle Info:
Year:
Make:
Model:
Color:
License #:
Insured?:	Yes      No
Registration Info:
Registration for 1st person	$50.00 ($40 if registered before June 1, 2012) Shirt Size: Select one Small Medium Large X Large XX Large XXX Large
Registration for 2nd person	$50.00 ($40 if registered before June 1, 2012) Shirt Size: Select one Small Medium Large X Large XX Large XXX Large	First Name:
1 2 3 4 5 No Additional Shirts @ $20 ea:	Size: Select one Small Medium Large X Large (S, M, L or XL)
1 2 3 4 5 No Additional Shirts @ $25 ea:	Size: Select one XX Large XXX Large (XXL or XXXL)
Credit Card Information:
Name on Card:
Card Type	Select one MasterCard Visa American Express
Account Number:
Security Code (back of card)
Expiration Date: