:__________________________________________
ADDRESS:____________________________________________________________
CITY:____________________________STATE_______________ZIP____________
YEAR:______________________ MAKE:_______________________________
MODEL:________________________________________
COLOR:________________________________________
MODIFIED: YES___________ NO_______________
CLUB AFFILIATION: YES__________ NO___________
NAME OF CLUB:________________________________________
HOW DID YOU HEAR ABOUT TODAYS
SHOW:___________________________________
HOW MANY MILES DID YOU DRIVE
TODAY:___________________________________________
BY SIGNING BELOW, YOU ACCEPT RESPONSIBILITY FOR YOUR VEHICLE AND
YOURSELF. YOU RELEASE FROM LIABILITY THE CITY OF FREDERIC, THE
VILLAGE PARK AND THE CAR SHOW ORGANIZERS.
OWNER/PARTICIPANT
SIGNATURE_____________________________________________
EMAIL ADDRESS:
____________________________________________________