SOUTHEAST VIRGINIA STREET ROD ASSOCIATION

2008 picnic registration form

 NAME ___________________________________________________________

ADDRESS_________________________________________________________

CITY_____________________________STATE__________ZIPCODE________

MAKE OF VEHICLE_______________________YEAR________MODEL_________

TELEPHONE NUMBER  [_____] __________________

PRE-REGISTRATION - SEPTEMBER 15TH

$20.00/CAR/FAMILY [2-ADULTS/2-CHILDREN]     EACH ADDITIONAL ADULT - $5.00 / CHILD - $3.00

AFTER SEPTEMBER 15 AND DAY OF PICNIC

$25.00/CAR/FAMILY [2-ADULTS/2-CHILDREN]     EACH ADDITIONAL ADULT - $6.00 / CHILD $4.00

NUMBER OF ADULTS______________NUMBER OF CHILDREN_________

ADDITIONAL ADULTS_____________ADDITIONAL CHILDREN________

TOTAL AMOUNT ENCLOSED  $__________________

MAKE CHECK PAYABLE TO: SOUTHEAST VIRGINIA STREETROD ASSOCIATION

MAIL REGISTRATION TO:     

BILL TREADWELL

416 WOODLAKE ROAD 

VIRGINIA BEACH, VA. 23452

FOR ADDITIONAL INFORMATION CALL 757-650-3667  OR EMAIL tbears3@aol.com

PLEASE READ, SIGN AND SEND RELEASE FORM WITH THE REGISTRATION
 

NO ALCOHOL - NO LOUD MUSIC - NO MOTORIZED SCOOTERS

LIABILITY RELEASE:

IN CONCIDERATION OF THE RIGHT TO PARTICIPATE, ENTRANTS, PARTICIPANTS, AND SPECTATORS, BY EXCEPTION OF THIS ENTRY FORM, RELEASE ND DISCHARGE THE SOUTHEAST VIRGINIA STREET ROD ASSOCIATION AND THEIR OFFICERS, EMPLOYEES, AGENTS, REPRESENTITIVES, AND ANYONE ELSE CONNECTED WITH THE MANAGEMENT OR PRESENTATION OF THE 16TH ANNUAL STREET ROD PICNIC AND ANY AND ALL KNOWN OR UNKNOWN DAMAGES, INJURIES, LOSSES, JUDGEMENTS, AND/OR CLAIMS FROM ANY CAUSE WHAT SO EVER.

SIGNATURE_____________________________________________________

[I have read and understand]

GUARDIAN SIGNATURE ___________________________________________

[if under the age of 18]

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