Lakeside RV Park Livingston, La. 70754   1-225-686-7676

Last Name, First Name, Spouse First Name____________________________________________________________

Address City. State. Zip Code_____________________________________________________________________

Telephone No.___________________ Bounder Yr._______ Length_______ Tow Car: Yes___ No__

Arrival:________________ Departure:________________ LAR No.__________ BOA No.________

FEE FOR 2 PERSONS (Members)                                     $110.00 ___________

FEE FOR 2 PERSONS (Bounder Buddies)                          $115.00 _____________

                                                                                                    TOTAL PAID $____________

Name of LAR member sponsor for Bounder Buddy: __________________________________________

Rally fee includes 3 nights camping (full hookups).

Rally rate good 2 days before and 2 days after. Contact Park to register & pay for extra days.

PLEASE MAIL RALLY PAYMENT AND REGISTRATION FORM ASAP BUT NO LATER THAN AUGUST 2nd, 2005 TO:

Phyl Patin (Secretary)  7014  PR1145  Midway, Texas 75852  . MAKE CHECK PAYABLE TO LA-ARK ROOS.