Jolly Roger H3
Pirate Invasion Hash Cruise IV
(8th Anniversary)
January 23-29, 2011
Registration
 

Hash Name (If none put NONE):

 

 Mortal Name (First, Last):

 

Mailing Address (####, Street Name, City Name, State and Zip Code):

 

 Area (Closest Major City, State, Province & Country)

 
E-Mail Address (Primary):

 		 Phone Number & Area Code (###-###-####):

 		 Birthday (##-##-####):

 		 Citizenship (Country):

 
Gender (M or F):

 		 Men's Shirt Size (S, M, L, XL or 2XL):

 		 Home Hash:

 		 Other association with hashing (relative, friend, etc):

 

Type Cabin (Inside, Outside, Balcony, JR Suite, Delux Suite):

 

 Cabin Mate 1:

 
Cabin Mate 2:

 		 Cabin Mate 3:
:
 

Release and Indemnity Agreement: Hashing may be a dangerous activity involving walking or running over various types of terrain in unpredictable weather. I accept the risk involved, and will not hold anyone but myself responsible for my actions. I can hurt myself if I want to and if I do it’s my own damn fault! I AM OF LEGAL DRINKING AGE.
Signature:                                                                                                                                                                                               Date:

 

The rego fee is $100 per person until August 26th, 2010, $120 until November 9th, 2010 and $140 after that.. The rego fee remains at $140 after November 9th, but you cannot be guaranteed a pirate pak (goody bag). Checks must be post marked by the appropriate date. Send check or money order along with the above filled out form to RICHARD GEERS, 7007 Orvicti Ct, Wesley Chapel, FL 33544.

Send an email to dab@jollyrogerh3.com with the above info and you will be added to the Who's Coming List.