AMERICAN TRIKE ASSOCIATION

ATA Registration 2011

PRE-REGISTRATION DEADLINE IS JULY 1, 2011 Return This Form With Payment to: ATA Secretary: Ruth Martin 418 East Bennett Buffalo, WY 82834 e-mail: rith-m@bresnan.net Phone: 307.684.7928	ATA Rally Dates –Aug 4th - Aug 6th 2011 Buffalo, Wyoming Indian Campground Pre-Registration Information Required Per Attendee: MEMBER #____________ NAME_________________________________________________ ADDRESS______________________________________________ CITY, STATE ZIP_____________________________________________ Telephone_______________________Cell#____________________________ E-MAIL_________________________________________________________ Emergency Info: (Medical Decision Maker in Case of Emergency) Name_______________________________Relationship__________________ Address__________________________________________________________ Telephone #’s_____________________________________________________ Secondary Contact Name___________________________________________ Address__________________________________________________________ Telephone #’s_____________________________________________________ Special Medical Information (allergies etc.)____________________________
Additional Contacts	Registration Fees
Tom Parish, President (307) 637-4105 corvetttom1@aol.com Kindy Parker, Vice-President (715) 964-2001 Indian Campground Registration (307) 684-9601 e-mail address: indianc@trip.com Buffalo Chamber of Commerce (800) 227-5122 e-mail: buffalochamber@wyoming.com Web Site for Accommodations buffalowyo.com	Members Non-Members New Membership $10 ________ Renewal Membership $10 ________ Rally Fee $5 ________ Rally $10 _________ Banquet $10 ________ Banquet $12 _________ Cookout Free ________ Cookout $7 __________ Poker Run – Per Hand $5 ________ Poker Run $5 _________ Trike Games Included in Rally Fee, Please Circle the Appropriate Items I will be Participating in Trike Games YES / NO Passenger / Driver