SITE # _____________________

33^rd CHALLENGE IN THE HILLS

MAY 26 & 27, 2012

CAMPER PRE-REGISTRATION

*1 NAME________________________________________________________________

ADDRESS_____________________________________________________________

CITY_______________________________ STATE_______________ ZIP_________

PHONE_____________________________ DATE_______________________

SIGNATURE___________________________________________________________

(YOU MUST BE 18 YEARS OR OLDER TO REGISTER A CAMPSITE)

EMAIL________________________________________________ (For confirmation)

Please bring confirmation form with you to ticket gate when you arrive.

NOTE: The site # is also the vehicle #, so each vehicle will have to register to a site.

Race machines with no license are excluded.

DEADLINE FOR PRE-REGISTRATION IS MAY 14, 2012 – NO EXCEPTIONS!

ABSOLUTELY NO REFUNDS!!

*1 APPLICANT CAMPSITE & SPECTATOR FEE $ 25.00

PLEASE LIST ALL GUEST OVER 12 YEARS OLD

(Anyone under 18 must be camping with parent/guardian)

2. __________________________________________________ $ 25.00

3. __________________________________________________ $ 25.00

4. __________________________________________________ $ 25.00

5. __________________________________________________ $ 25.00

6. __________________________________________________ $ 25.00

Total Due with registration $__________

Mail Forms with payment to: TUCKER CO. 4-WHEELERS

PO BOX 116

PARSONS, WV 26287

NOT RESPONSIBLE FOR ACCIDENTS

**************************OFFICE USE ONLY*********************************

PRE-REG INFOR

CHECK $________________________________

MONEY ORDER $________________________

Processed by _____________________________

Confirmation _____________________________