2001 Fall VAR Pre-Registration

Primary Registrant __________________________________NSS# __________________

Address ___________________________________________City ___________________

State __________ Zip _____________________ e-mail ____________________________

Phone ( ) _____________________Grotto affiliation ____________________

Secondary Registrants (from same household)

Name _____________________________________________ NSS# _________________

Saturday Evening Meal Will Be Furnished!

** Vegetarian meal for primary or secondary registrants - Number needed ________

Number of registrants _ X $18.00 = $____

Children age 5 and under _____ X FREE = $ 0.00

Pets (Leashed and Controlled at all times – NO EXOTIC PETS) _____ X $5.00 = $________

Please make checks payable to RASS and return with this form by September 8th, 2001 to:

2001 Fall VAR

c/o Rich Geisler

11501 Greenwood Rd

Glen Allen, VA 23059

For further information please see our website at:

/grotto/rass/