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Registration Form for COAA Quassy Amusement Park Rally
Middlebury, CT
August 25-26, 2012
Registration deadline is August 8, 2012
Name: _______________________________________________ Telephone: _______________
Address:________________________________________________________________________
City, State, Zip__________________________________________________________________
E-mail Address:__________________________________________________________________
Number of people attending _____ X $ 15.00 each. Total amount $___________
Saturday Evening Social at Quassy 6:30 P.M. Check here if attending social________.
BBQ chicken, rice pilaf, salad, beer, wine, soft drinks, at the private patio overlooking the lake.
Make check or money order payable to COAA.
Return check and this registration form to:
Ron Gustafson
Quassy Amusement Park
PO Box 887
Middlebury, CT 06762
Names as you want them to appear on badges:
1) _______________________________________ 4) ____________________________________
2) _______________________________________ 5) ____________________________________
3) _______________________________________ 6) ____________________________________
Organ Registration
If you plan on bringing one or more organs to play, please provide the following information
to assist with planning and placement:
Make __________________________________Model / key size _______________________
Organ is on a:Trailer____ Truck____ Free Standing Overall length needed (feet) ________
Power required? ___________ Please bring plenty of extension cords! Quassy is a small historic
"Trolly Park" and all of the walkways are paved where organs will be placed. There are shaded areas!
For early arrivals large organs in trailers and trucks will be placed on location until 5 P.M. Friday, Aug. 24.
Estimated placement & set up time: Day__________Time_____________
Estimated departure time. Please circle: Day______________ Time____________
Middlebury, CT
August 25-26, 2012
Registration deadline is August 8, 2012
Name: _______________________________________________ Telephone: _______________
Address:________________________________________________________________________
City, State, Zip__________________________________________________________________
E-mail Address:__________________________________________________________________
Number of people attending _____ X $ 15.00 each. Total amount $___________
Saturday Evening Social at Quassy 6:30 P.M. Check here if attending social________.
BBQ chicken, rice pilaf, salad, beer, wine, soft drinks, at the private patio overlooking the lake.
Make check or money order payable to COAA.
Return check and this registration form to:
Ron Gustafson
Quassy Amusement Park
PO Box 887
Middlebury, CT 06762
Names as you want them to appear on badges:
1) _______________________________________ 4) ____________________________________
2) _______________________________________ 5) ____________________________________
3) _______________________________________ 6) ____________________________________
Organ Registration
If you plan on bringing one or more organs to play, please provide the following information
to assist with planning and placement:
Make __________________________________Model / key size _______________________
Organ is on a:Trailer____ Truck____ Free Standing Overall length needed (feet) ________
Power required? ___________ Please bring plenty of extension cords! Quassy is a small historic
"Trolly Park" and all of the walkways are paved where organs will be placed. There are shaded areas!
For early arrivals large organs in trailers and trucks will be placed on location until 5 P.M. Friday, Aug. 24.
Estimated placement & set up time: Day__________Time_____________
Estimated departure time. Please circle: Day______________ Time____________
