ENTRY FORM
BENTON
COUNTY HEALTH DEPARTMENT FUND RAISING TEAM
Warsaw
City Harbor
Warsaw,
Missouri 65355
NAME__________________________________________________
ADDRESS___________________________PHONE_____________
VEHICLE_______________________________________________
CLASS________________ MILES DRIVEN TO EVENT__________
CLUB AFFILIATION_______________________________________
$15 PRIOR
TO DAY OF SHOW
As a participant in the Classic Car Show at Warsaw Harbor in Warsaw MO, I
do hereby hold harmless for liability on behalf of any of the organizers,
sponsors, participants, and owners, or incidental third parties during any of
the activities. I grant permission
to the organizers to use my name, any photographs or any other record of the
event for purposes of advertising or trade or for any legitimate purposes
whatsoever without compensation.
________________________________
________________
Signature
of Participant
Date
Mail entry forms to: Kelli
Daleske
kellidaleske@yahoo.com
30503 Hwy MM
Warsaw,
MO 65355