Car Show Registration

Wearin' O' the Green

Name____________________________________________________

Address__________________________________________________

________________________________________________________

Phone______________________ email________________________

Car Information:Make_____________________________________

Model______________________Year________________________

Amount Enclosed_________________________________________

Signature________________________________________________

By signing and submittingthis registration form I hold Chautauqua Cruisers, Inc.; Walton County ShrineClub; and any or all officers and members of said organizations harmless in theevent of damage, theft or other loss to my vehicle or myself while inattendance at the above indicated event.

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