4th Annual - Pathways Health Centre for Children

presents
SATURDAY, MAY 21, 2016
4th Annual
Over $17,000 raised
for children’s programs
in Sarnia-Lambton!
Co-Sponsors
Class Sponsors
5 Best
Poker Hands Win
500
$
Lunch provided to driver.
Lunch Sponsor
Registration
Rules
$25 includes lunch
Passenger eligible to purchase
an extra poker hand for $25.00
with valid driver’s license. Lunch
included.
1. MUSTANGS ONLY!
Registration 8:00 am • Rally begins at 10:00 am
For more information: www.mustangsallyrally.com
Registration:
$25.00 includes lunch
Passenger eligible to purchase an extra poker hand
for $25.00 with valid driver’s license. Lunch included.
Return to:
Please make cheques* payable to: Pathways Health Centre for Children
*Post-Dated Not Accepted
Please Print
ENTRY FORM
PRE-REGISTRATION DEADLINE IS MAY 16, 2016
Mustang Sally Rally
c/o Pathways Health Centre for Children
1240 Murphy Road
Sarnia, ON N7S 2Y6
For information,
call Wendell Drysdale
(519) 491-2265
or visit
www.mustangsallyrally.com
Name:
Yr/Model/Colour:
Address:
Club Affiliation:
City:
Email Address:
Prov./State:
Postal/Zip Code:
Phone Number:
Registering for: Rally ❑ _____ Spots @ $25
LIABILITY
In consideration of the acceptance of the right to participate, entrants, participants and spectators by execution of the entry form, release and discharge the
Pathways Health Centre for Children, City of Sarnia, Lambton Ford, Ford Canada, any other participating sponsors, the Province of Ontario and their officers,
employees, agents, representatives and servants and anyone else with unknown damages, injuries, losses, judgements and/or claims from any cause whatsoever
that may be suffered by the entrant to his person or property. Further, each entrant agrees to indemnify all of the foregoing entities, firms, persons and bodies of
and from any and all liability occasioned or resulting from the conduct of entrants or any participant assistant or cooperating with entrants under the direct control
of the entrant.
Signature:
Dated this
Day of
2016