Heart of the Sandhills Road Ride Registration
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   Riders Name __________________________  Passenger Name _______________________



   Address ______________________________________  AMCA Number __________________



   City _____________________  State _______  Postal Code _______  Country ______



   Motorcycle ___________________________________  Model ________________________



   Registration is $125.00 per Rider -----------X ___________ = _________________



   Registration is $65.00 per Passenger --------X ___________ = _________________



   T-Shirts $20.00 -----------------------------X ___________ = _________________
      Sizes   [  ]Small    [  ]Medium   [  ]Large   

              [  ]XLarge   [  ]XXLarge


                                                        Total = _________________



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             Registration and payment must be recived by  May 15th, 2011
              Please make checks payable to the Omaha Chapter AMCA, Inc.
                                       Send To
                              Omaha Chapter AMCA, Inc.
                         PO Box 1712, Bellevue, NE 68005
               For more info call Road Captin Bob Alf at (402) 660-8063

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