Driver Information
Drivers name:
Address:
City:
State:
Zip:
Phone:
E-mail:
Great Lakes Four Wheel Drive Assoc. Membership
Select Yes to purchase a 1 year membership to GLFWDA (recomended)
No
Yes
A one year membership fee of $40 will be added
Select Yes to purchase a weekend only membership.
No
Yes
A weekend membership fee of $5 will be added
As a GLFWDA Sanctioned Event, membership is required.
If you are already a member enter your GLFWDA number here:
Head Count
# of Adults:
# of Children (ages 11-17):
# of Children (age 10 and under)
DOA 2010 Apparel
Enter total quanities in each box according to size.
S
M
L
XL
2XL
3XL
T-Shirt $18 (S-XL) $20 (2XL-3XL)
Sweatshirt $28 (S-XL) $30 (2XL-3XL)
Total:
(Hover mouse over submit to update total)
Payment Method:
By Mail (Check)
Online (Credit Card / PayPal)
ATTENTION:
All Registrations are subject to final review by MSG for accuracy.