Cotex V | Registration Form

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COTEX V Registration Form

Name:___________________________________________________________________

Hash Name:______________________________________________________________

Home Hash: _____________________________________________________________

Email:___________________________________________________________________

Phone___________________________________________________________________

Address:_________________________________________________________________

Sex: M F

Shirt Size:___________________________________________________

Enclosed $69.69, payable to Michael D. Barton post marked by 15 May, 2004.

I ________________________(printed name) do understand that if I hurt myself, it's my own damn fault! I cannot / will not fault or blame the COTEX management, TRACTOR Brewery, Budget Inn or the city of Santa Fe, New Mexico.

Date _______________________ Signature ___________________________________