Registration Form - City of Airway Heights

CLASSICS, AMERICAN MUSCLE, STREET RODS,
HOT RODS, RAT RODS, TRUCKS, IMPORTS/TUNERS,
CUSTOMS, UNDER CONSTRUCTION, AMERICAN IRON
US BIKES, CUSTOM BIKES, IMPORT BIKES.
REGISTRATIONINFORMATION:PLEASEPRINTCLEARLY
FIRST&LASTNAME: ADDRESS:
CITY:
STATE:
PHONE: EMAIL:
MAKE:
MODEL: YEAR:
☐StreetRod
CLASSIFICATION:Pickone
☐Classic ☐MuscleCar ☐HotRod
☐RatRod
☐SportsCar
☐Import/Tuner
☐CustomCar/Truck ☐ImportBike ☐AmericanIronBike☐CustomBike ☐UnderConstruction
LIABILITYWAIVER:
I,theundersigned,herebyfullyreleaseandagreetoholdharmlessand
indemnifytheCityofAirwayHeights,itssubsidiaries,agents,volunteers,
sponsors,employees,members,successorsorassignsofanykindfromany
andallclaimsand/orliabilitiesforloss,damage,injury,orliabilitythatmay
occurduringmyparticipationinthe2016AirwayHeightsDaysevent.
Additionally,Idoherebygrantpermissionthatanyphotosand/orvideo
takenoftheeventbytheeventstafforvolunteerscanbeusedfor
promotionalpurposes.
Signature(Required) Date