JCCA's Eastern Association's 
Chincoteague Island Event 
October 20-22 2006 

REGISTRATION FORM

Name:					________________________
	
Address:					________________________

						________________________
 
Home phone:				________________________
(in case of an emergency)

Number of People Attending:		______
	
Registration Fee:				$25/person
Includes: JCCA T-Shirt, Friday Night Dinner
NOTE: Children under 12 attend free (no-T-Shirt)

Total Included:					_______

Shirt Sizes:

M _____	L _____	XL _____	2XL _____

Payment method:

__ Paypal (send funds to paypal@jeepstercommandoclub.com)

__ Check

Checks should be made out to: 
Jeepster Commando Club of America

Checks & registration should be mailed to:
Jeepster Commando Club of America 
PO Box 9791 
Asheville, NC 28815