Arkansas 2012 Spring Samboree
*** Spring Time in Arkansas *** April 19, 20, 21, 22, 2012
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 Competetion - Commercial Venders - Good Entertainment - Golf Scramble
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FACILITIES: Limited Electric & Water - Dump Stations & Showers
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PARKING: Early Bird Parking $17.00 per night, payable when registering, you may arrive as early as
1:00PM Monday, April 16, 2012. Come together, Park together. You will be parked by the State Wagon Master
and his Staff. A holding area, Prior to Sunday is available, $2.00 per night in the front of the Coliseum.

REFUNDS: Refunds will be made (less $10.00) or FULL Amount Transfered to Next Samboree If Requested 30 Days in Advance of Samboree.

--------------------------- REGISTRATION FORM ------------------------------------
Pre-Registration must be received by April 9, 2012
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:
If you are a member of an Arkansas Chapter, Enter your 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 Samboree fee amounts below:
1 Rig with 2 Adults, Pre-Registered.............................. $65.00
1 Rig with Single Adult.................................................... $55.00
Each Additional Adult..................................................... $10.00
(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:
Linda Webb, Registrar
P.O. Box 1115
Paragould, AR 72451-1115
Phone# 870-335-6220
Email: Lg9322@aol.com
skyline2501@yahoo.com

We the Undersigned understand that The Arkansas Organization has taken Reasonable and Necessary Safety precautions and
we accept full responsibility for the welfare of our units and all persons in our units while attending the Arkansas Samboree.

Signature_______________________________________________________ Date_____________
We reserve the right to refuse admission to anyone.
ALL PETS MUST BE ON A LEASH AT ALL TIMES AND THE OWNER CLEANUP AFTER THEM!!!
IF THEY POOP, YOU SCOOP. NO PETS IN THE BUILDINGS.
Copyright © 2008 Arkansas Good Sam. All rights reserved. Revised: 12/23/10