| REGISTRATION for Prospectors Car Club Show-N-Shine (4 Corners Downtown) August 29, 2010 |
| Name:___________________________________________________Phone:______________________________ |
| Address:____________________________________________________________________________________ |
| Vehicle Year/Make/Model:______________________________________________________________________ |
| Club Affiliation (if applicable):________________________________________________________________ |
| Show & Shine (Sunday, August 29 2010). $10 per car. | # of Cars:_________ |
$_______________ |
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| Prospectors T-Shirts. Limited supply available. Please pre-order and pre-pay.$20 each for Adult sizes (S - XXXL). $10 each for Children sizes (M or L). Please state how many of each size you would like to order.
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# of Adult T-Shirts Ordered @ $20 each: _________ # of Child T-Shirts Ordered @ $10 each: _________ |
Total for Adult T-Shirts:$________ Total for Child T-Shirts:$________ |
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| Please make cheques payable to: Prospectors Car Club P.O. Box 4265 Quesnel, B.C. V2J 3J3 |
Total money included with this registration form: $_______________ |
| Waiver: Applicant hereby 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: ______________________________________________________Date:____________________________ PARTICIPANTS UNDER THE AGE OF 19 YEARS must have the following waiver signed by either a parent or legal guardian. As the below participant(s) is/are 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. Underage participant(s): ______________________________________________________________________________ Signature of parent/legal guardian: _____________________________________Date:_____________________________ If needed, contact Steve McGilloway for more information at 250 991-5074. |