Michigan State Rally

September 16-19, 2010

Lansing Cottonwood Campground - Lansing, Michigan

Reservation deadline:  August 25, 2010

Please send signed registration/disclaimer form below and check payable to:

Eugene or Arleen McBride

P. O. Box  31  - Burnips, MI  49314

Tel. 1-616-896-1368 or Cell 1-616-460-5408

Name: ______________________________________________________Klub # _____________

            His                        Her                                    Last

Address:_________________________________________________________First Rally?_____

City:_____________________________ State_____ Zip:___________Phone:________________

Cell:__________________________ Email:__________________________________________

Guest(s)___________________________________________________________________

Handicapped?# ______ Diabetic?# _______ Golf#? _________ Early Arrival? ______

                                                                                                  Total Enclosed:_____________

Disclaimer:  All persons attending a Klub rally must sign this disclaimer in order to participate.

I agree, in consideration for being able to participate in this Newmar Kountry Klub activity, to release and to indemnify and hold harmless Newmar Kountry Klub and Newmar Corporation, it’s directors, officers and employees, from all liability for injury or damages to my person or 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 this release and indemnity as part of my application.

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

Signature: _________________________________________ Signature: ___________________________________________

Signature: ________________________________________ Signature: ___________________________________________