Please Print this Form And Mail it in with your Check

Or use Active for credit card registrations with no service charge!!

 

Name: _______________________________________

 

Address: _____________________________________

 

_____________________________________________

             

Cell Phone Number: ________________________________

 

Email (print neatly, we need a valid email):

 

_____________________________________________

 

 

Emergency Contact    

 

Name:_____________________________________________

 

Cell Phone:_____________________________________________

 

 

 

Age at time of event: ____________________________

 

 

Entry Fee:  $240 covers all Four Days

                     

                      Add $65 for  QuadZilla Jersey

                      Mens S-XXL  _____     Womens XS-XL  _____

 

                        

Mail check payable to:

 

Mark Frank

7400 Shallow Creek Trail  Apt A

Victor, NY 14564