Dingman Township Presents

Car & Motorcycle Show in the Park

Sunday, May 19, 2019

DingmanTownship Rereational Park

679 Log Tavern Road, Milford, PA

Registration Form

 

CAR SHOW REGISTRATION FORM ENTRY# _______________* Township assigns

 

OWNER/PARTICIPANT NAME: ____________________________________________

 

ADDRESS: ____________________________________________________________

 

CITY:____________________________STATE_______________ZIP_____________

 

PHONE:_____________________          E-MAIL_______________________________

 

YEAR:______________________MAKE:_______________ MODEL:______________

 

COLOR:____________ MODIFIED: YES___________ NO_______________

 

CLUB AFFILIATION: YES__________ NO___________

 

NAME OF CLUB:________________________________________________________

 

HOW DID YOU HEAR ABOUT TODAY’S SHOW? _____________________________

 

HOW MANY MILES DID YOU DRIVE HERE TODAY? __________________________

 

In consideration of the acceptance of my participation in the Car & Motorcycle Show in the Park on Sunday, May 19, I, the undersigned, intend to be legally bound, I for myself, my family members, employees, agents heirs and assigns, executors, and administrators, hereby waive and release any and all claims which I or they might have against Dingman Township, Dingman Township Board of Supervisors, Dingman Township Parks and Recreation Commission, their officers, employees, volunteers and participants as a result of my participation in the above program.  I further agree to indemnify Dingman Township, its officers, employees and volunteers against claims made against it or them as a result of my participation in the above program.

 

Signature: __________________________________   Date:___________

 

Please return form to: Dingman Township,118 Fisher Lane, Milford, PA  18337

You may mail it, drop it off, fax it to 570-296-2150 or e-mail it to: recbd@ptd.net

Form must be returned by May 13, 2019.

                                                                                                    

Drive-Ins will be welcome the day of the Show.

 

$10.00 entry fee Check # _________  Cash _________

 

Proceeds of the event will be donated to:

Pike County Humane Society

(donations of food, supplies for the Food Pantry and PCHS will be accepted)