REGISTRATION FORM - BIG-HUMP 2010 Bungle in the Jungle - Aug. 20, 21 & 22nd

Hash name________________________________

Nerd name ________________________________

Resident Hash______________________________

Address___________________________________

City ______________________________________

State _________________Zip_________________

E-mail ____________________________________

Phone ____________________________________

If we receive your payment by June 15th:

_________ I want it all - Staying in the Cabin! ($140.00) What a deal!!! All inclusive: Cabin, Floating, Hashing & Giveaways

_________ I want it all - Staying in my own tent! ($105.00) What a deal!!! All inclusive: Camping, Floating, Hashing & Giveaways

_________ Float Trip and Dinner only - NO Giveaways! ($50.00)

Shirt size? _____ Med _____ Large_____ XL _____ XXL

Vegetarian? _____ Yes _____ NO

Do you want your hash name & e-mail on the Who's Coming web page? _____ Yes _____ NO

CUSTOMARY DISCLAIMER
I hereby release the Hash House Harriers from responsibility for any injuries, deaths, debts, pregnancies or any other misfortune which may befall me related to my participation in this event. In other words, if I get hurt, it's my own stupid fault.

SIGNATURE:_____________________________ DATE: ____________________


Make checks payable to Barb Mickeletto and mail to:

Barb Mickeletto
436 Caroline Ave.
St. Louis, MO 63122