Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone (###) ### #### Cell Phone (###) ### #### Second Family member First Name Last Name Share my address with our sponsors? YES NO Share my email/phone in club directory for members? YES NO I have read the NWRA Waiver & Release of Liability Form and understand and agree to the terms for myself and all family members. YES NO Thank you!