2024 November Chow Call (Luncheon) 11:00 AM Registration Form

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Start Date: 2024-11-14       Departure Date: 2024-11-14

Hideaway Pizza

  • Address: 326 N. Main St., Crestview, FL 32536
  • Phone:
  • For Reservations Contact:

Sponsor(s): White Sands Panhandlers

Host: Chuck Kuzma     Phone: (850) 803-8761     Email: ckuzma116@cox.net


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

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 Chuck Kuzma, 116 Duke Drive, Niceville, FL 32578.