Twin Rivers Registration
November 11 – 14, 2010

Please fill out the registration form and submit it electronically.

Please fill out the registration form completely. By hitting the SUBMIT Button below your registration will be submitted to The Western Federal Blues.
 On submitting the registration you will see a message that your registration was submitted successfully.
If your registration was not submitted successfully you will receive a notice asking you to resubmit your registration.

THIS IS A TWO PART PROCESS. Register here and then proceed to the Registration Payment page to pay your registration fee.

Registration deadline to participate with the Western Federal Blues at Twin Rivers is October 10, 2010.
 
Event registration is $20.00 per person plus $12.00 Ration Fee
$32.00 fee total

Name  

Address

Age:    (Must be 16 to carry a rifle.) 

If under 18, Individual Responsible at Event:

Phone 

Email 

Website 

Company Affiliation and Commander for Event 

Application for Officer or NCO position – please give brief account of experience:


Emergency Information 

Emergency Contact Person 

Emergency Contact Phone Numbers

Medications Currently Taking


Do you have medications with you?    yes     no

Please fill out the registration information electronically and pay your event dues through
PayPal (PayPal fees will apply.) If you do not have access to internet you may mail this
form to Western Federal Blues c/o Chad Greene, 1760 Whites Rd., Perryville, KY 40468.

Please make event dues payable to WESTERN FEDERAL BLUES.
Registration will only be considered complete when event dues are received. 
A confirmation will be sent upon completion of registration. 
REGISTRATION DEADLINE is October 10, 2010.