KANSAS STATE RALLY

August 18-21,2011

Deer Creek Valley RV Park

3140 SE 21st Street, Topeka, Kansas 66053

785-357-8555

Your are to make your own site reservations with them,

and tell them you will be with the KansasState Newmar Rally for the discounted price.

RallyFee INCLUDES:

Two Full Breakfasts

One Continental Breakfast

Two Buffet Dinners

Ice Cream Social

Entertainment

RALLYFEES:

2 People $ 140.00

1 Person $ 70.00

This does NOT include your campgroundreservations

Camping will be $26 a night. Please specify which nights

when you make your reservations with the campground.

Then please send us your information and your rallyfees.

* RESERVATIONDEADLINE *         July 22, 2011

Mail signed disclaimer & fees to:

Larry DeWitt (11440L)

P.O. Box 337

Madison, Kansas 66860-0337

620-437-6325

NewmarKountry Klub Rally Registration & Disclaimer Form

Type of Rally: ___KANSAS STATE RALLY_____ AmountEnclosed: ___________

Name(s):_______________________________________ Klub #: _____________

Address:___________________________ City:________________State: __________

Zip:_________

Phone: ___________________________ E-mail: _____________________________

Dates & Location of Rally: August 18 – 21, 2011

Deer Creek Valley RV Park, Topeka, Kansas

DISCLAIMER:

All persons attending a Klub rally must sign thisdisclaimer in order to participate.

I agree, in consideration for being able to participate inthis Newmar Kountry Klub activity, to release and to indemnify and hold harmless Newmar Kountry Klub and Newmar Corporation, its directors,officers and employees, from all liability for injury or damages to my personor property, or the property of persons who accompany me to this activity. With knowledge of the type of risk or harm,which might occur at such activity, I sign and release and indemnify as part ofmy application and participation.

All adult members and their guests must signand in so doing, assume responsibility for minors in their care.

Signature(s): _____________________________________________________________________

Signature(s): ____________________________________________________________________

Signature(s): _____________________________________________________________________

Signature(s): _____________________________________________________________________

Return this signed form with your payment to:

Larry & Sherry DeWitt

P.O. Box 337

Madison, Kansas 66860

Questions: 620-437-6325

PLEASEREMEMBER TO CALL THE CAMPGROUND

TO MAKEYOUR SITE RESERVATIONS!