| REGISTRATION for Prospectors Car Club 2008 Gold Pan Steak-out August 22, 23 & 24/08 • Quesnel, BC Held at Kersley Community Hall, Highway 97 South and Downtown at the 4 Corners Registration: Friday, 5 - 9 pm & Saturday, 10 - 11 am (Kersley Hall) Sunday, 9 am - noon (4 Corners, Downtown) |
| REGISTRATION FEES | |
| Car, Driver, Guest and 2 children under 16 years for Dinner, Dance & Show & Shine................$50.00 Dinner & Dance only (couple).....................................................................................................$40.00 Dinner & Dance only (single)......................................................................................................$20.00 Show & Shine only (Sunday) ........................................................................................per car, $10.00 |
Saturday dinner tickets sold in advance only: Cocktails at 6 pm, dinner served 6:30-7:00 pm in Kersley Arena
Drivers Name: ___________________________________________ Number of Guests: __________
Address: _______________________________________________ Phone:____________________
_______________________________________________
City: __________________________________________________ Postal_____________________
Vehicle Year & Make:_________________________________ Model:_____________________
Club Affiliation (if applicable:______________________________________________
WAIVER: APPLICANTHEReBY ASSUMES any and all responsibilities for injury or damage caused by him/herself of any member of his/her party, while participating in the Gold Pan Steak-Out, and does release from liability for any such injury or damage the Quesnel Prospectors Car Club and its members.
Signature of driver:_____________________________________ Date: ______________________
PARTICIPANTS UNDER THE AGE OF 19 YEARS must have the following waiver signed by either a parent
or guardian. As the below participant is under the legal age, I will be responsible for any
injury and damage caused by him/her or any member of his/her party while participating in the
Prospectors Car Club Steak-Out, and do release from liability for any such injury or damage the
Quesnel Prospectors Car Club and its members.
Signature of parent/legal guardian:___________________________ Date: ______________________
GOLD PAN STEAK-OUT T-SHIRTS: Limited supply available. Please pre-order & pre-pay. Be sure to
specify the number of T-Shirts ordered and the required size for each one.
Adult Sizes•$20.00 each Small_____Medium_____Large_____Xlarge_____XXLarge_____XXXLge_____
Address: _______________________________________________ Phone:____________________
_______________________________________________
City: __________________________________________________ Postal_____________________
Vehicle Year & Make:_________________________________ Model:_____________________
Club Affiliation (if applicable:______________________________________________
WAIVER: APPLICANTHEReBY ASSUMES any and all responsibilities for injury or damage caused by him/herself of any member of his/her party, while participating in the Gold Pan Steak-Out, and does release from liability for any such injury or damage the Quesnel Prospectors Car Club and its members.
Signature of driver:_____________________________________ Date: ______________________
PARTICIPANTS UNDER THE AGE OF 19 YEARS must have the following waiver signed by either a parent
or guardian. As the below participant is under the legal age, I will be responsible for any
injury and damage caused by him/her or any member of his/her party while participating in the
Prospectors Car Club Steak-Out, and do release from liability for any such injury or damage the
Quesnel Prospectors Car Club and its members.
Signature of parent/legal guardian:___________________________ Date: ______________________
GOLD PAN STEAK-OUT T-SHIRTS: Limited supply available. Please pre-order & pre-pay. Be sure to
specify the number of T-Shirts ordered and the required size for each one.
Adult Sizes•$20.00 each Small_____Medium_____Large_____Xlarge_____XXLarge_____XXXLge_____
| SEND CHEQUE (made out to Prospectors Car Club),
FORM AND T-SHIRT ORDER TO: PROSPECTORS CAR CLUB, PO BOX 4265, QUESNEL, BC V2J 3J3 INFO? CONTACT JO MITCHELL, (250) 992-3285 |
T-Shirt Order Total:______________ Registration Total:______________ AMOUNT REMITTED:______________ |