2025 Lunch at Rogue Roundabout Registration Form

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Start Date: 2025-07-10       Departure Date: 2025-07-10

Rogue Roundabout


Sponsor(s): AR Hogs

Host: Donnie Reed     Phone: (501) 837-4766     Email: shelpingothers@gmail.com


Muster Costs:

Single Cost: $0.00   Couple Cost: $0.00   Couple + Guest Cost: $0.00  

Registration

An entry in all fields shown in the registration form is required.

Pilot:   SMART#:

Copilot:   SMART#:

   

Pilot's Email:

       

In Case of Emergency (ICE) Contact Information

Please provide at least one emergency contact other than your Copilot.

   

   

RV Information

       

       

I tow a vehicle behind my motor home.  

Attendees:   One Person $0.00.00   Two Persons $0.00.00   Two plus Guest $0.00.00

I (We) are first time attendee(s).

Guest Name:   Enter guest first and last names or “None.”

     

Handicap Parking         30 Amps   50 Amps

Do you or your traveling companion use any of the following, cane, walker, electric wheel chair, scooter, C-PAP?  

If Yes, please indicate which one(s):

Special Diet Needs  

His:  

Hers:

  I will volunteer to help at the Muster

Tours

  Tour#1 2025 Lunch at Rogue Roundabout in Conway - Cost: $0.00

The Reeds are hosting a luncheon at Rogue Roundabout in Conway on July 10th at 1130. Address is 804 Chestnut St. Conway, AR 72032. The cost of lunch is on your own. Website below. Please RSVP   Total: $

Liability Release

In consideration for my (our) attendance, I (We) hereby release and agree to indemnify and hold harmless SMART, its officers, directors, employees, agents, successors, and assigns from any and all liabilities, claims, losses, and/or damages arising from my (our) attendance at this event.

All attendees must read and sign this form.

Name Signature Date
Pilot:
Copilot:
Guest:

This event does not have a muster fee. Please mail a copy of this form to Donnie Reed, 57 Glade Heights Road, Sherwood, AR 72120.