Dingman
Car & Motorcycle Show in the
Park
Sunday, May 19, 2019
CAR SHOW REGISTRATION FORM
ENTRY# _______________* Township assigns
OWNER/PARTICIPANT NAME:
____________________________________________
ADDRESS:
____________________________________________________________
CITY:____________________________STATE_______________ZIP_____________
PHONE:_____________________
E-MAIL_______________________________
YEAR:______________________MAKE:_______________ MODEL:______________
COLOR:____________
MODIFIED: YES___________ NO_______________
CLUB AFFILIATION:
YES__________ NO___________
NAME OF
CLUB:________________________________________________________
HOW DID YOU HEAR ABOUT
TODAY’S SHOW? _____________________________
HOW MANY MILES DID YOU
DRIVE HERE TODAY? __________________________
In
consideration of the acceptance of my participation in the Car & Motorcycle Show
in the Park on Sunday, May 19, I, the undersigned, intend to be legally bound, I
for myself, my family members, employees, agents heirs and assigns, executors,
and administrators, hereby waive and release any and all claims which I or they
might have against
Dingman Township, Dingman Township Board of Supervisors, Dingman Township Parks
and Recreation Commission, their officers, employees, volunteers and
participants as a result of my participation in the above program.
I further agree to indemnify
Signature:
__________________________________
Date:___________
Please return form to:
You may mail it, drop it
off, fax it to 570-296-2150 or e-mail it to:
recbd@ptd.net
Form must be
returned by May 13, 2019.
Drive-Ins will be welcome
the day of the Show.
$10.00 entry fee Check #
_________ Cash _________
Proceeds of the event will
be donated to:
(donations of food, supplies
for the Food Pantry and PCHS will be accepted)