Name: ________________________________________________________________

Address: ______________________________________________________________

City: ________________________________________State: ________ Zip: ________

Phone: ______________________ Email: ____________________________________

Weekend Package (please check one)

______ Food, dancing and camping* for the weekend PLUS a leisurely rafting trip down the Clark Fork River ... $125.00 a person

______ Food, dancing and camping* for the weekend ... $85.00 a person

______ Food and dancing for the weekend* PLUS a leisurely rafting trip down the Clark Fork River ... $90.00 a person

______ Food and dancing for the weekend* (for those staying at a motel or other camp sites) ... $60.00 a person

______ One NIGHT (either Friday or Saturday) of supper and dancing … $30.00 a person

______ Friday or Saturday Dance Only ... $15.00 a person

I (we) plan to stay in a ... Tent __________ Trailer __________ RV __________ Camper __________ or Off-Site__________

* Included in the price is a souvenir T-shirt ... Size S ____ M ____ L ____ XL ____ XXL ____

You can pay through PayPal using your bank checking acount or your favorite Credit Card.

The Paypal ID is treasurer@PacificNWGRA.org

With your Paypal payment please include your T-shirt size and your choice of camping, etc.

Or you can send your reservation payment (make checks payable to PNWGRA) along with the registration form to:

Jeff Taylor
c/o PNWGRA
100 Four Mile Road
Saint Regis MT 59866