The River Cruizers - Roddin' on the River Entry Form

OFFICIAL ENTRY FORM

My signature below confirms my intended participation in the RODDIN' ON THE RIVER car show. In consideration for participation in this event, I hereby release and discharge the RODDIN' ON THE RIVER run committee, the RIVER CRUIZERS, INC. CAR CLUB and The RIVERSIDE RESORT, the CITY of LAUGHLIN, CLARK COUNTY and the STATE of NEVADA or any officers, members, employees, agents or affiliates; from any and all known and unknown damages, injuries, losses, judgments or claims for any cause suffered by me personally or my property, as well as anyone under my direction or control. I also agree to indemnify, without consideration, reservation or qualification, all of the aforementioned persons from any and all liabilities occasioned from actions or conduct of any person assisting me, cooperating with me, under my direction or myself.

Canopies or other shade structures are my sole responsibility and must be secured at all times.

I HAVE READ AND DO UNDERSTAND THE STATEMENT ABOVE AND REALIZE THAT MY SIGNATURE HEREON LIMITS MY RIGHTS AT LAW.


Signature:	_______________________________________	Date:	__________________________

Name	_____________________________________________________________________________

Mailing Address (P.O. Box)	________________________________________________________

City	_____________________	State	____	Zip	___________

Phone	_________________________		E-Mail	____________________________

Vehicle Year	_____	Make	________________	Model	_________	Color	________

T Shirt Size

Small

_____

Medium

_____

Large

_____

XXL

_____

XXXL

______

Club Affiliation	___________________________	City	__________________	State	_____

Please Circle Years You Have Attended:	92 93 94 95 96 97 98 99 2000 2001 2002 2003 2004 2005

Email Address (optional, for entry confirmation)	_____________________________________________

ENTRY FEE $45 FOR FIRST ENTRY AND $25 FOR EACH ADDITIONAL ENTRY

Make checks payable to: THE RIVER CRUIZERS, INC.

Mail entries to:	RIVER CRUIZERS RODDIN' ON THE RIVER
	C/O Neal & Velma Shupe
	2290 Flathead Road
	Fort Mohave, AZ 86426

For More Information Call: 928-788-2174 or Email desertnv@citlink.net

"RODDIN' ON THE RIVER" is a registered trade name of THE RIVERCRUIZERS, INC.. of Bullhead City, Arizona and is not associated in any way or has given permission for its use to an other club, organization, company or promotional agency.