Event Registration

Registration Page

When you have submitted this form your name will be added to the conformation page.

Don't use "enter" to jump to next field. It will submit your incomplete registration. Use Tab to move to next field

Please complete form and submit. Please mail check or money order payable to: Eric Louria 3219 Albin Lane Orlando, FL 32817
First Name
Last Name
Nick Name (if any)
Chapter Number
Street Address
City and State
Zip Code
Daytime phone
Email Address
If you are an officer enter rank
Registration is $25.00 and will include a short-sleeve event T-shirt. an event pin or a State Rally patch/rocker.
Shirt Size	Sm. Med. Lg. XL 2XL 3XL4XL
Click here for shirt color Colors will vary depending on your computer monitor	Black Dusk Blue Charcoal Dark Chocolate Forest Green Navy Maroon
Do you wish an Extra Shirt? (Additional $15.00 each)	Yes No Enter Quantity, Color and Size of each additional shirt
Is this your first Florida State Rally?	Yes No
Do you wish an Event Pin or a State Rally patch/rocker?	Pin Patch/Rocker (Both for first time attendees, rockers only for returning guests)
Do you wish an extra event pin or a State Rally patch/rocker? (Additional $5.00 each)	Yes No List extra items desired
Be sure to add up your total and send check or money order to the address provided at the top of this form. Reg. Cost $25.00 Additional Shirts $15.00 ea. Additional Pins or Rockers $5.00 ea.