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2015 QLD STATE HOG RALLY
www.qldhogrally.com
Registration Form
Friday 18th – Sunday 20th September 2015
Mt Gravatt Showground. 1644 Logan Road, Mt Gravatt. Qld
Early Bird Registration:
(Closes 31st May, 2015)
$175.00 Per Adult
Includes: 3 Day pass, Entertainment, Show n Shine, Thunder Run & other events. Friday Night sit down meal and
Saturday meal Vouchers AND (if current financial International HOG Member) Rally T-shirt, Rally Patch & Rally Pin.
Also includes a free cooked breakfast Fri/Sat at Gasoline Alley Harley-Davidson.
Guest & General Registration:
(Closes 30th August, 2015)
$175.00 Per Adult
Includes: 3 Day pass, Entertainment, Show n Shine, Thunder Run & other events. Friday Night sit down meal and
Saturday meal Vouchers. Also includes a free cooked breakfast Fri/Sat at Gasoline Alley Harley-Davidson.
Children 9-17 years:
(Closes 30th August, 2015)
$ 75.00 per child
Includes: 3 Day pass entry to rally activities, Friday Night sit down meal, Saturday meal Vouchers.
Also includes a free cooked breakfast Fri/Sat at Gasoline Alley Harley-Davidson. (Under 9 years entry is free)
Registration details: An automatic email confirmation will be sent when you register on-line. Alternatively all queries &
confirmation of registration & payment will be sent via email to the Primary member listed below.
Primary Contact Full Name:
Full Name:
Address:
Address:
P/Code:
P/Code:
Email:
Email:
Chapter:
Chapter:
HOG No: AU
HOG No: AU
Contact No:
Contact No:
Bike Rego:
Bike Rego:
Guests and Children (if Child please enter age) 0-8 years of age – FREE (but please still indicate attendance)
Full Name:
Full Name:
Age:
Age:
Address:
Address:
P/Code:
P/Code:
Email:
Email:
Contact No:
Contact No:
Please note: The rally t-shirt, patch & pin is only available to current HOG Members. If your child is attending and is an
Associate HOG member and they want the rally pack the full Early Bird price of $175.00 is payable.
Rally Shirts – (Please write quantity of shirts required in box next to sizing)
Men’s T-shirts
Ladies T-shirts
S
M
L
XL
2XL
Sm
Med
Lge
XLarge
6-8
10-12
14-16
18-20
2XL
20-22
3XL
4XL
To help with catering for Breakfast at the Dealership please
indicate how many will be attending.
Friday
Saturday
Accommodation Options:
1. Camping
On-site camping is available $25 per site per night. Some powered sites available.
Own Tent
Thursday
Own Van
Friday
Total
Nights
Saturday
2. Hotel/Motel: Refer website for hotel / motel accommodation listings & links and special rally rates.
Payment Required:
Early Bird Registrations
@ $175.00pp
x
Adults
$
(Includes Full Rally Pack)
@ $175.00pp
x
Children (9-17 years)
$
Guest & General
Registration
@ $175.00pp
x
Adults
@ $ 75.00pp
x
Children (9-17 years)
$
@ $ 25.00p/n
x
Nights
$
TOTAL AMOUNT PAYABLE
$
Camping
$
Payment Options:
Option 1 - Cheque/Money Order made payable to: “Qld HOG Rally’
Option 2 - Credit Card
Option 3 - EFT Payment
Name on Card ____________________________________
BSB:
Visa / MasterCard / Amex + 2% surcharge
A/C No:
Card # __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
633 - 000
15-434-8791
Expiry Date ___ / ___ CVN ...... ...... ...........
Signed ____________________________________
A/C Name: “Qld HOG Rally”
Ref: AU....................................... (use HOG international number)
Ref: AU..............................(use HOG international number)
Early Bird Registration closes 31st May, 2015: Registrations received after this date will not guarantee Rally Tshirt, Rally Patch or Rally Pin.
Cancellation/No-show Policy: - A 15% handling fee for all cancellations is applicable. After 30th August, 2015 no
requests for refunds will be accepted. No-shows can contact [email protected] within 30 days after the
event for their package to be posted for a cost of $15.00 per pack payable in advance.
Registrations are non transferable.
Please Post original form to ‘2015 QLD State HOG Rally, PO Box 860, PARK RIDGE. Q 4125
or Scan and Email the completed Registration Form to: [email protected]
Please Do NOT send CASH with registration forms
The Legal Bit - H.O.G. Member to read and sign:
I declare that I will be a financial member of H.O.G. International at the time of the 2015 Qld State HOG Rally. I accept that no person
registered on this form will hold the Harley Owners Group (Gasoline Alley Chapter Inc), or Gasoline Alley Australia Pty Ltd
Harley-Davidson, Mt Gravatt Showground’s, 2015 Qld State HOG Rally committee, or any other party involved with the Rally including
their agents and officers responsible for any loss, damage or injury from participation in the Rally.
Signature: _________________________________________ Date:…….……/…………../……..………
Office Use Only - Initial:
Date Rec’d
/
/
Registration No: