
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