| Registration Information |
*ALL FIELDS ARE REQUIRED*
|
| Personal Information |
Street Rod Information |
| Name |
|
Make
(must be 1962 or earlier)
|
|
| Address |
|
Model |
|
| City |
|
Year |
|
| State |
|
Color |
|
| Zip Code |
|
Engine Model |
|
| Phone |
|
Engine Year |
|
| Email |
|
|
|
| |
|
Club or Other Affiliation |
|
| |
|
| Camping Information (ALL must be registered) |
|
Trailer
|
No. of Nights |
|
|
Tent
|
No. of Nights |
|
|
Motor Home
|
No. of Nights |
|
|
**Camping during the Round Up is FREE**
For Pre-event camping pricing and information please call Larry at 301-697-0142
or the Allegany County Fairgrounds at 301-729-1200
|
| |
| Signature |
|
|
By Check is Box I am authorizing this as my Signature to Complete my registration form and am agreeing to the following terms: |
| |
In consideration of the acceptance of the right to participate, entrants, participants and spectators, by execution of this form, release and discharge the Western Maryland Street Rod Association Inc. and their officers, directors, employees, agents, representatives, servants and anyone else connected to the management of presentation of the Rod Run of and from any and all known or unknown damages, injuries, losses, judgments and or claims from any causes 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 and under the direction or control of entrant. |