Texas Good Sam Chapters Samboree
Postal Registration Form

Date: _____________________

Samboree Year: _________      Spring _____     Fall _____
  
Pilot’s Name: ___________________________________________________________
                                 (Last)                                                        (First)

Navigator’s Name: ___________________________________________________________
                                (Last)                                                        (First)


Address: _________________________________________________

City: ______________________ State: _____  Zip: ________ 

Good Sam No. __________________  Expiration Date: ___________

Home Phone: (____) _______________  Cell Phone: (____) _______________ 

E-Mail: __________________________

Rig Type: __________________ License #:____________ State Rig Licensed In: _____
                
Make of Tow(ed) Vehicle: _____________ License #:____________ 

State Vehicle Licensed In: _____

First Texas Samboree?  _____Yes  _____No

Commercial Vender?    _____Yes

In Case of Emergency, contact:

Name: ____________________________________

Phone: ____________________

Number of Adults in Rig: _____


Mail Registration to:	JoAnn Birchett, Registrar
       P.O. Box 236
Bishop, TX 78343
Phone:   (361) 584-1919
E-mail: txgoodsam@aol.com