Tom

Arkansas Spring Samboree
*** BUILDING BRIDGES OF FRIENDSHIP ***

April 15, 16, 17, 18 2010
Four States Fairgrounds, 3700 E. 50th Street, Texarkana, AR. 71854

Shirley

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 Competetion - Commercial Venders - Good Entertainment - Golf Scramble
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
FACILITIES: Limited Electric & Water - Dump Stations & Showers
^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^
PARKING: Early Bird Parking $12.00 per night, payable when registering, you may arrive as early as
1:00PM Sunday, April 11, 2010. Come together, Park together. You will be parked by the State
Wagon Master and his Staff. A holding area is available in the front of the Coliseum.

-------------------------------------------------- REGISTRATION FORM ---------------------------------------------------
Pre-Registration must be received by April 07, 2010

First Name Spouse's Name Last Name
Street Address
City
State/Province Zip/Postal Code Home Phone
E-mail

Enter your Good Sam member number: Expiration date:
Enter your chapter name.
Is this your first Samboree? Yes No 
Is this your first Arkansas Samboree? Yes No
Enter children's names & ages (under 18-no charge).

Please refer to the appropriate Samboree fee amounts below:

1 Rig with 2 Adults, Pre-Registered.............................. $60.00
1 Rig with Single Adult................................................... $55.00
Each Additional Adult.................................................... $15.00
(If not Pre-Registered will add $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 Samboree
Mail form to:
Melinda Wiggs, Registrar
2501 Skyline Point
Jonesboro, AR 72404
870-972-0951


mwiggs2501@yahoo.com

By your signature you understand and you 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, therefore,
I/WE accept full responsibility for the welfare of my/our unit while attending the above indicated Arkansas Samboree.
The Arkansas Good Sam reserves the right to refuse registration and/or admittance to anyone.

Signature___________________________________________________________ Date_____________

  Copyright © 2008 Arkansas Good Sam. All rights reserved. Revised: 12/12/09