Fairbanks Offroad Lions, March of Dimes On/Off Road Rally Registration Form

June 27th 2015

Your name:

Phone number:

Address:

Your e-mail address:

Online pre-registration is $50 per vehicle and $55 on the day of event. Will you be registering online for the Rally? Yes No

Number of people attending:

Only one vehicle is allowed per registration. Year/Make/Model of vehicle:

Will you be making a donation to MOD? Yes No

If making a donation, please enter amount:

If you have any additional concerns or questions please feel free to include them here or contact the Fairbanks Offroad Lions at 907-378-8240 or email: fairbanksoffroadlions@gmail.com

Please make all checks payable to Fairbanks Offroad Lions indicating March of Dimes in the For: line, and can be mailed to: PO Box 71456 Fairbanks Alaska 99707, or if arrangements need to be made to receive payment please note above.

After you click the e-mail button the page will refresh with a simplified version of your information. You can print this out to send with your check. Thank You!