Registration Form

Return with check or money order (made to Clan Egan Rally) to James Eagen, 4610 Brad Court, Rockville,MD 20853. Reservations & Payments are due as soon as possible.
Family Name:________________________

Family Address: ______________________

_____________________________________

Telephone number:_(____)____________


Names for those 18 and over:
___________________________x $20.00
___________________________x $20.00
___________________________x $20.00
___________________________x $20.00

Subtotal:______



Names and ages for those under 18:

Name

Age Name Age
___________________ ______ ______________________ ______
___________________ ______ ______________________ ______
___________________ ______ ______________________ ______


Beds (two twin beds per room, some singles) for each day:

Friday

Saturday Sunday Monday
__________ __________ __________ __________ Total___ x $35= Subtotal:_____
Max # beds on any night x $17= Subtotal:_____
Bus Seats Monday #___________ x $8 =

Subtotal:_____

Banquet Tickets: Saturday night
Age 18 and over: #______ x $35 = Subtotal:_____
Under age 18: #________ x $25 = Subtotal:_____
Crabfeast Tickets: Sunday afternoon/evening
#_____ x $35 Subtotal:_____




Meal Tickets:

Friday

Saturday Sunday Monday ---------------
Breakfast _________ __________ __________ _________ Total x $4 = Subtotal:_____
Lunch _________ __________ __________ *________ Total x $5 = Subtotal:_____
Dinner _________ *_________ *_________ _________ Total x $8 = Subtotal:_____

*Do not schedule if taking bus, attending banquet, or attending Crab Feast

Aodagain T-shirts:
______ small x $11 = Subtotal:_____
______ medium x $11 = Subtotal:_____
______ large x $11 = Subtotal:_____
______ X-large x $11 = Subtotal:_____

Grand Total Check

_______________

Please add note for any disability accommodation necessary, and we will try to arrange for it.