Car Show Registration Form

  Full Name_______________________________________________________________ 

 Address_________________________________________________________________     

 City_____________________________  State_______________   Zip _______________   
 
 Phone _____________________  E-mail Address _______________________________
 
 Make ______________________ Model______________________   Year ____________ 

Waiver of liability and assumption of risk agreement must be signed to participate:
On acceptance of this entrant for the Greater Pine Island Elks Lodge 2781 car show, I expressly release all members, directors, officers, agents, sponsors, or anyone related to the event in any way from any cause whatsoever that may be suffered and /or claims that may be incurred by myself. I understand that each participant is responsible for any damage to his/her vehicle and personal property. I state my vehicle is insured against personal injury and/or property damage.

Signature ____________________________________    Date ____________________