Registration
“CARS & CYCLES AGAINST CANCER”
Pre-Register NOW!!! $15.00/vehicle or cycle
Extra T-Shirts $10.00 ea. How many & SIZES??_________________
NEW WEEKEND: JUNE 10-11TH, 2011
“CARS AND CYCLES AGAINST CANCER”
Blytheville, AR
All Proceeds to American Cancer Society
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1 Free T-Shirt=What size would you like? ___________
Name:_____________________________________________
Address:__________________________City:________________State:___
Zip:_________Phone:____________________Cell:____________________
EmaiL:_______________________________________________________
Vehicle: Year:____ Make:___________Model:_____________Color:_____
Distance to Show:______miles Club:______________________________
Liability Release: The “Relay for Life” organization, the organizers of the “Cars & Cycles Against Cancer” car show or anyone else connected with the presentation of this event are in no way responsible for known or unknown damages, injuries, losses, judgments or claims from any causes whatsoever that may be suffered by participants to his/her property or person.
Signature: ___________________ Date:___________
MY VEHICLE/BIKE IS HERE IN HONOR/MEMORY OF: Please put loved one’s name here: _________________________________
For Teenage Award: Are You under 20 yrs. Old??? Yes____ No___
Please Mail This Form & check to : “Cars and Cycles Against Cancer”
Att: Steve Southard
Steve Southard 1135 Terry Lane
870-623-2605 Blytheville, AR 72315
