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Address:
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City:
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State:
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Zip:
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Year & make of Car:
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Club Affiliation:
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Shirt Size MED. LG. XL. XXl.
XXXL. (add $2 for XXL & XXXL) |
E-mail
Address:
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Miles
Driven To RUN:
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(Not
Responsible for Loss or Accidents)
(NO
ALCOHOLIC BEVERAGES ALLOWED)
Complete and mail with Check or Money Order to :
The Rebel Run
| THE REBEL RUN |
| 1505 Blair Rd. |
| Harrod, Oh. 45804 |
A confirmation of entry and
official entry number will be furnished by return mail.
ENTRY AND ADVERTISING RELEASE: In consideration of this
entry, car owner and guest agree to permit the REBEL RUN the use of their
names and pictures of the car for publicity, advertising, and commercial
purposes (including newspapers, magazines, radio, and television) before,
during and after the event and do hereby relinquish any rights whatsoever to
any photos taken in connection with the event and give permission to publish
or sell or otherwise dispose of said photographs. All publicity and
advertising rights reserved by the REBEL RUN.
LIABILITY : In consideration of the acceptance of the
right to participate, entrants, participants, and spectators, by execution
of this entry form, release and discharge the REBEL RUN, Allen County
Fairgrounds, The City of Lima, State of Ohio, Allen County, and their
officers, directors, employees, agents, representatives, and anyone else
connected with the management or presentation of the show of and from any
and all known or unknown damages, injuries, judgments, and/or claims from
any cause whatsoever that may be suffered by any entrant to his person or
property. Further, each entrant expressly agrees to indemnify all of the
foregoing entities, firms, persons, and bodies of and from any and all
liability occasioned or resulting from the conduct of entrants or any
participant assisting or cooperating with entrant under the director or
control of the entrant. We reserve the right to refuse any entry. (
Sorry, NO REFUNDS)
SIGNATURE OF ENTRANT (and Guardian if under 18)
X________________________________________________________________
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YOUR SIGNATURE IS REQUIRED |
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