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* 1. First and Last name:

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* 2. Phone Number:

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* 3. Street address:

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* 4. Email:

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* 5. What is the Year, Make, Color, Plate Number, Color, Class Entered, and Model of your Vehicle/Motorcycle?

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* 6. Entry and Advertising Release: In consideration of the foregoing entry, car owner, family and guests agree to permit Crosby Church use of their names, photographs and photographs of their car for publicity and advertising (including newspapers, magazines, radio, and television) before and after the event, and do hereby relinquish any rights to any such photographs taken in connection with the event, and give permission to publish or dispose of said photographs to Crosby Church.

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* 7. Liability:
In consideration of the acceptance of the right to participate, entrants, participants, and spectators by execution of this form, release and discharge Crosby Church, the officers, and members of Crosby Church and/or anyone else connected with management or presentation from any and all known and 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 agrees to indemnify all the foregoing entities, firms, persons and bodies from any and all liability occasioned or resulting from the conduct of entrants or any participant assisting or cooperating with entrant and under direction or control of entrant.

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* 8. I submit this form and acknowledge that all above is true. (Type first and last name).

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