18th John's Rod and Custom Picnic
Entry Form
APPLICATION #.........
| Name | |
| Address | |
| Phone | |
| Year & Make of Vehicle | |
| Registration Number | |
| Type and Colour |
CAR ENTRY FEES:
| Weekend Family Car Entry: (2 adults & children under 14) $45.00 | $ |
| Weekend Driver Only: ( Buddy passes $10.00 per day, $20.00 w/end) $35.00 | $ |
| Saturday Entry: Family*....$20.00 Driver only....$15.00 | $ |
| Sunday Entry: Family*....$35.00 Driver only....$25.00 | $ |
| YES I want [......] t/shirts, sizes[.........] @ $18.00 ea | $ |
| Pre-entry Single Pack (before October 10), includes 1 t/shirt $45.00 | $ |
| Pre-entry Family Pack* (before October 10), includes 1 t/shirt $55.00 | $ |
Total |
$ |
We agree to release John’s Rod & Custom, Kustoms of Australia, their agents, associates, Lardner Park Management, and everyone connected with the event, from all and any liabilities in regards to damages, injuries, or losses to ourselves and/or our property, arising in relation with this event. We authorise KOA and their agents to take and use images of ourselves and/or our cars in promotions, publications, DVD’s etc. Attendance of the event confirms acceptance of the above terms.
Signed......................... Date.......