Text Box: MEMORIAL WEEKEND “CRUIZIN’ WITH THE OLDIES” HOSTED BY: OIL CAPITOL AUTO CLUB, CASPER, WY MAY 28, 29 ,30, 31, 2010 REGISTRATION: PARKWAY PLAZA HOTEL 123 WEST "E" ST. CASPER, WY. 82601 (307) 235-1777-(800) 270-7829 INFORMATION: PHIL NISSEN DIANNE BUTLER, EVENT REGISTRATION RAY PARNELL EVENT CHAIRMAN 80 VALLEY DRIVE CLUB PRESIDENT (307) 235-8889 CASPER, WY 82604 (307) 277-9565 (307)234-3236 ______________________________________________________________________________ Mail to: Oil Capitol Auto Club, 80 Valley Dr., Casper, WY 82604 PLEASE PRINT CLEARLY NAME_______________________________________________________PHONE__________________ ADDRESS________________________________CITY_________________STATE_____ZIP_________ YOUR CLUB AFFILIATION _____________________________________________________________ $40.00 ENTRY FEE FOR THE FIRST VEHICLE OR MOTORCYCLE (INC. TWO ADULTS 2 CHILDREN UNDER 12) ($5.00 More for each additional person in your group for food) $15 ENTRY FEE FOR ENTRANT UNDER AGED 25 IN YOUNG GUN CLASS (MUST OWN VEHICLE AND HAVE A VALID DRIVER’S LICENSE) - VEHICLE CAN BE ANY YEAR, MAKE, MODEL, TYPE $10.00 ENTRY FEE FOR EACH ADDITIONAL VEHICLE OR MOTORCYCLE (DOES NOT INCLUDE ANY EXTRA PEOPLE) PLEASE COMPLETE THE FOLLOWING FOR YOUR FIRST VEHICLE ENTRY: VEHICLE YR________ MAKE______________ MODEL________________ ORIG. INTENT ____ TRUCK / 4X4 ______ “YOUNG GUN” - (ENTRANT 25 YRS OR YOUNGER) ________ DATE OF BIRTH _____/_____/_____ PLEASE COMPLETE THE FOLLOWING FOR YOUR SECOND VEHICLE ENTRY: VEHICLE YR_______ MAKE______________ MODEL__________________ ORIG. INTENT ____ TRUCK / 4X4 ______ “YOUNG GUN” - (ENTRANT 25 YRS OR YOUNGER) ______ DATE OF BIRTH _____/____/_____ PLEASE COMPLETE THE FOLLOWING FOR YOUR MOTORCYCLE ENTRY MOTORCYCLE ENTRY: YEAR_______ MAKE________ MODEL____________ CLASSES (CHECK ONE) VINTAGE (PRE 1980) ______ MODIFIED______ AMERICAN/FOREIGN_______ T-Shirts $15 S_____ M______ L______ XL______ 2X ______ 3X ______ 4X_______ **CAR CLUB CHALLENGE: THE CAR CLUB WHO HAS TRAVELED AT LEAST 100 MILES & WHO HAS THE MOST REGISTERED VEHICLES IN THE SHOW WILL WIN $500 CASH. THIS IS SPONSORED BY SUPER SUDS AUTO WASH, 2220 CY AVE., CASPER, WY. We need numbers attending the functions: Sat. Noon Cruise-In #_____ Sat. Night Sock Hop # ____ Sunday Night Awards / Ice Cream Social # _____ Monday Breakfast # _______ ***OIL CAPITOL AUTO CLUB MEMBERS WILL NOT COMPETE AGAINST VISITORS FOR AWARDS. CLUB MEMBERS WILL BE IN A SEPARATE CLASS As an entrant in the event if you are not already a full-fledged member, you will be granted Associate Membership in the Oil Capitol Auto Club for 2010. This will entitle you to all benefits due members except for voting privileges. Release of liability: Any participant under the age of 18 must have a parent or legal guardian sign the application. In consideration of the right to participate, entrants & participants by execution of this entry form, release and discharge the Oil Capitol Auto Club, City of Casper, Natrona County & State of Wyoming, their officers, directors, employees, agents, representatives and servants, and anyone else connected with the management or presentation of the "Memorial Weekend Cruizin’ With The Oldies " activities from any and all known or unknown damage, injuries or losses, judgments, and/or claims from any cause whatsoever that may be suffered by any entrant to his person or property. Further, each entrant expressly agrees to indemnify all of the forgoing entities, firms, persons and bodies from any and all liability occasioned or resulting from the conduct of any entrant(s), participant(s). TOTAL AMOUNT ENCLOSED$_____________ NUMBER IN PARTY ATTENDING: Adults____Kids_____ SIGNATURE: ______________________________________GUARDIAN________________________