Car Show Entry Form

6th Annual Orinda Classic Car Show Entry Form
Saturday, September 25, 2010

Location: Orinda Village at Orinda Motors, 63 Orinda Way
Setup: 8:30 - 9:30 am
Start: 10:00 am
Parade: 2:00 pm

Complete and mail this entry form and your tax-deductible entry fee check of $50 for cars and $35 for motorcycles made payable to Seniors Around Town to: Chip Herman, 2 El Caminito, Orinda CA 94563
Questions? Email ChipHerman@Earthlink.net
Seniors Around Town Tax ID: 94-609-8323

Owner

Address

Phone #

Email Address

Car/Motorcycle Manufacturer
Year

Model

Body Style

History of car/motorcycle or interesting facts about the car (do not complete if you have entered this car/bike before)

Would you be interested in participating in the “Parade of Classic Cars” after the show at 2:00pm?
YES  NO 
Would you be interested in giving a ride in your car in the parade to someone who makes a donation to our charity?
YES  NO 
Would you like to pre-order a commemorative “Orinda Classic Car Show “2010” t-shirt for $5 off the price of the shirts the day of the show? Please add an additional $15 to your registration check.
YES  NO  Shirt Size: S  M  L  XL  XXL 

I understand that by signing below, I release Seniors Around Town, Orinda Motors Inc., the event organizers and other sponsors from any and all liability and or responsibility for any and all damages that may occur on the day of the Orinda Classic Car Show at Orinda Motors (Orinda, CA), resulting directly or indirectly from activities at the event. I also understand that I am responsible for my vehicle and its contents. I verify that I carry automobile insurance on the vehicle that I am displaying at the event.

Signed_________________________________________________________ Date______________