2023 ARKANSAS STATE RV RALLY REGISTRATION

ARKANSAS HOE-DOWN

APRIL 12 - 16, 2023

FOUR STATES FAIRGROUNDS, 3700 E. 50TH STREET, TEXARKANA, AR 71854

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

ACTIVITIES: Hospitality - Arts & Crafts - Flea Market - Samgo Cash Prizes - Ice Cream - Games Competition

- Commercial Vendors - Live Entertainment - Golf Scramble

FACILITIES: Limited Electric and Water - Dump Station - Showers

LIMITED FULL HOOKUPS - ARRIVE WITH EMPTY HOLDING TANKS

PARKING: Early Bird Parking Monday - April 10 - $30.00 per night, payable when registering. Come together, park

together. You will be parked by the State Wagon Master and his Staff beginning Monday at 1:00 PM or earlier if possible.

Prior to Monday a Holding Area is available in front of the Fairgrounds Office.

All pets MUST be on a leash. No pets in buildings. PETS POOP - YOU SCOOP

Refunds will be made (minus $10.00) OR full amount transferred to the next Arkansas RV Rally if requested 30 days in advance.

Pre-registration with fees must be received by March 24, 2023 GAMES BEGIN ON WEDNESDAY, APRIL 12

First Name _________________________Spouse's Name______________________

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Last Name__________________________ Street Address___________________________________________

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City________________________________ State/Province_____________________________

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Zip/Postal Code____________________ Home Phone___________________________________

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E-Mail_____________________________________

Good Sam Member Number _________________________Expiration Date ____________________

If you are a member of an Arkansas Chapter, Chapter Name ________________________________________________

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First State RV Rally? Yes_________ No________ First Arkansas RV Rally? Yes________ No________

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Do you require Handicap Parking? Yes_________ No________ HC#____________________________

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Children's Names and ages attending (under 18 - no charge) _____________________________________

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Please refer to the appropriate RV Rally fee amounts: 1 Rig with 2 Adults, Pre-registered $90.00 $______________

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1 Rig with Single Adult $85.00 $______________

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Worker's Special: Friday & Saturday $75.00 $ ______________

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Each Additional Adult $15.00 $ ______________

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If not Pre-registered, $10.00 will be added $ ______________

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Enter the total fees included with this pre-registration form: $ ______________

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Make check payable to: Arkansas GS/Treasurer and Mail form to:

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Helen Tinkle, Registrar 96 Grant 533, Hensley, AR 72065

Phone: 501-680-3398 Email: Helen.tinkle@yahoo.com

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Your cancelled check will serve as your receipt - no confirmation will be sent.

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By your signature, you understand and agree to abide by the terms and conditions indicated below:

I/We the undersigned understand the Arkansas Good Sam Organization has taken reasonable and necessary safety

precaution and I/We accept full responsibility for the welfare of my/our unit and all persons therein while attending the

Arkansas RV Rally.

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Signature_________________________________________________Date_________________________________

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The Arkansas Good Sams reserves the right to refuse registration and/or admission to anyone.