(HIGH LIGHT THIS FORM THEN PRINT)

Name:____________________________________________

Address:__________________________________________

City:____________________ State:_______ Zip:_________

Phone:___________________________

Car Make:________________ Model:________________

Color:____________________ Year:_________________

Classification:_____________________________________

Club Affiliation:____________________________________

Number of Years Attended___________________________

Email Address_____________________________________

~ Early Bird Full Registration Fee .00
~ Full Registration after April 30th .00

I would like T-Shirts in sizes:

~S M L XL (circle one) .00

~XXL XXXL (circle one) .00

~ Embroidered Hats .00

Operation: Event management reserves the right to restrict behavior of all entrantsoffs, Any violation is reason for eviction. There will be no refund of money if a participant is evicted.

Liability: In consideration of your accepting my entry, I, intending to be legally bound for myself, my heirs, executors, and administrators, do hereby release and discharge the All Wheels committee, all sponsors and supporters, and City of Jacksonville, Duval County, and all other contributors from any and all liability arising from damages, illness, injury and/or physical consequences I may suffer as a result of my participation in this event. I understand that my entry fee is nonrefundable. I have read the information provided and certify my compliance by my signature below.