Show and Shine Registration

Contact Information

Name *

Mailing Address

Street Address or PO Number *

City *

State *

Zipcode *

Email Address *

Phone Numbers

Main Phone Number (Required) *

This phone number is required. We will try to reach you at this number. If we cannot reach you at this number, we will try to reach you at the other optional phone numbers you might specify below.

Cell Phone (Optional)

Entries

Year: *

Make: *

Model: *

Total Entry Fee:

General Liabialty Waiver

Liability: In consideration of the acceptance of the right to participate, entrants, participants and spectators by execution of the form, release and discharge The Townsend Rotary Club of and from all known and unknown damages, losses, injuries, judgements, and/or claims from any cause that may be suffered by entrants to his person or property. Each entrant agrees to indeminify all forgoing entities, forms and person of any and all liability occasioned or resulting from the conduct of an entrant or participant assisting with the entrant and under the direction or control of the event.

I have read, understand and Agree to the Liability Waiver *

Contact Information: For more information contact:

Jerry: (406) 465-2331
Jamie: (406) 980-0122; email: jamiewilliams@yahoo.com

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Show and Shine Registration

General Liabialty Waiver

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