VENDOR -------- VENDOR -------- VENDOR-------- VENDOR -------- VENDOR
REGISTRATION FOR MISSISSIPPI FALL SAMBOREE
MID-SOUTH RV PARK & CONVENTION CENTER
111 RESORT VILLAGE RD, TUNICA RESORTS, MS 38664
SEPTEMBER 30- OCTOBER 3, 2010
ACTIVITIES
HOSPITALITY, GAMES,ARTS & CRAFTS, RAFFLES, SEMINARS, ENTERTAINMENT
DOOR PRIZES ,CAKE WALK, SAMGO ,GOLF TOURNAMENT, CHURCH SERVICE     
OUR THEME WILL BE "Magnolia Mardi Gras"
THURSDAY through SATURDAY MORNINGS               Pastry, With COFFEE     
SATURDAY NIGHT                                                       CATERED DINNER
WATER, ELEC. 30/50, Sewage, WiFi, & SWIMMING POOL  AVAILABLE
(Bring extra water hose with "Y" & Electric Cords)
Holding Area with full service 5:00 PM Arrival
MAKE CHECKS PAYABLE TO: GOOD SAM CLUB OF MISSISSIPPI
MAIL REGISTRATION FORM & CHECK TO:

Registrar: Bobbie Smith, 109 Sherrills Ln. Brandon, MS39047, Bo1El2@aol.com  Ph: 601-829-1883


________________________________- (CUT ON LINE) _______________________________
Tables IF available - - NO GUARANTEE                    Tables IF available - - NO GUARANTEE

SAMBOREE FEE INCLUDES: 2 PERSONS, 3 NIGHTS, CATERED DINNER FOR 2 ---------    $ 75.00    .
ADDITIONAL MEALS: (ALL AGES) __________@ $15.00 EACH  -------------------------------    $ _____     .
ADDITIONAL PERSONS: $5.00 EACH   -------------------------------------------------------------------  $ _____    .
IF NOT PRE-REGISTERED,FEES WILL BE $5.00 MORE AT REGISTRATION ---------------     $ _____    .
EARLY BIRD PARKING 
Sept. 28-29 @ $17.00 PER NIGHT-- PAY AT Registration Desk --- $ _____    .
ADDITIONAL BOOTH (10' X 10' ) ________ @ $50 ea. ---------------------------------- $ _____    .
Your canceled check is your receipt             TOTAL  ENCLOSED $ _______
*** Cancellation Fee ( Non Refundable)      $   5.00

***PRE-REGISTRATION DEADLINE POSTMARKED NO LATER THAN Sept. 18, 2010***

Good Sam # _________________________________________

NAME_____________________________________SPOUSE__________________________________

                                            PLEASE PRINT
ADDRESS______________________________________E-MAIL_______________________________

CITY___________________________________________STATE__________ZIP__________________

HANDICAP PARKING   YES _____ NO _____ *OFFICIAL # _________________________________

TELEPHONE NUMBER (____)________________CHAPTER_________________________________


FIRST TIME TO A MISSISSIPPI SAMBOREE  ?                YES_________ NO__________

Products for Sale: ____________________________________________________________________________________

NOTE:  We the undersigned, understand the Mississippi Good Sam Organization has taken reasonable and necessary  precautions; therefore we accept responsibility for our units and all occupants, while attending this Samboree.

SIGNATURE __________________________________________________________

* Requirement
  Form   011410

Mississippi

Good Sams

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