2019 ARKANSAS STATE RV RALLY* REGISTRATION * MAYBERRY, USA * April 11, 12, 13, 14, 2019 Four States Fairgrounds, 3700 E. 50th Street, Texarkana, AR. 71854

You may fill out this form online, print and mail in your pre-registration fees.

ACTIVITIES: Hospitality - Arts & Crafts - Flea Market - Samgo Cash Prizes - Ice Cream
GAMES COMPETITION - Commercial Venders - LIVE Entertainment - Golf Scramble
FACILITIES: Limited Electric & Water - Dump Stations - Honey Wagon & Showers
LIMITED FULL HOOKUPS - ARRIVE WITH EMPTY HOLDING TANKS
PARKING: Early Bird Parking $19.00 per night, payable when registering, you may arrive as early
as 1:00PM Sunday, April 7, 2019. Come together, Park together. You will be parked by the State
Wagon Master and his Staff. A holding area, Prior to Sunday is available in the front of the Coliseum.
All pets MUST be on a Leash, No Pets in Buildings, PETS POOP, YOU SCOOP
Refunds will be made (less $10.00) or FULL Amount Transfered to Next Arkansas RV Rally If Requested 30 Days in Advance
Pre-Registration must be received by April 1, 2019 Games Begin on Wednesday, April 10

First Name Spouse's Name Last Name
Street Address City <
State/Province Zip/Postal Code Home Phone
E-mail
Good Sam member number: No  Expiration date:
If you're a member of an Arkansas Chapter, Enter the chapter name.
Is this your first Samboree? Yes No 
Do You Require Handicap Parking? Yes No  HC #
Is this your first Arkansas Samboree? Yes No
Enter children's names & ages (under 18-no charge).
Please refer to the appropriate Arkansas RV Rally fee amounts below:
1 Rig with 2 Adults, Pre-Registered............................... $75.00
1 Rig with Single Adult.............................................. $65.00
Working Man's Special: Friday & Saturday.........................$55.00
Each Additional Adult................................................ $15.00
If not Pre-Registered, $5.00 will be added.........................$5.00
Enter the amount for each additional person over your rig fee:
Enter the total fees included with this pre-registration form:
Make check payable to: Arkansas RV Rally Mail form to:
Girtie VanHoveln, Registrar
P.O. Box 1202
Cabot, AR 72023
Phone: 501-454-9806 - vangirtie1990@yahoo.com
Your cancelled check will serve as your reciept -No conformation will be sent

By your signature you understand and agree to abide by the terms and conditions indicated below.
I/We understand The Arkansas Good Sam Organization has taken Reasonable and Necessary precautions and,
I/We accept full responsibility for the welfare of my/our unit and all persons therin while attending the Arkansas RV Rally.

Signature_____________________________________________ Date_____________
The Arkansas Goodsams reserves the right to refuse registration and/or admission to anyone.