OWNER INFORMATION
Last Name: First Name:
Address:
City: State: Zip Code:
Home Phone: Cell:
Email Address (required):
Name of vehicle EXHIBITOR (if different from OWNER):
Vehicle INFORMATION
Make: Model: Year:
Unique Feature(s):
Club Affiliation (if any):
REGISTRATION AND PAYMENT INFORMATION
Entry fee of $15 payable by check or credit card. Please send payment along with registration form to: Petersen Automotive Museum, c/o Clayton Drescher, 6060 Wilshire Blvd, Los Angeles, CA 90036
Or EMAIL/FAX this completed form to: 323-964-6422 ATTN: Clayton Drescher
You may pay by check through mail or by email/fax with a credit card:
Credit Card Number: Exp. Date:
First Name on card: Last Name on card:
VISA/MC/AMEX/Disc: Signature (retype name):
If you are uncomfortable submitting your payment information by email or fax, please call Clayton at 323-964-6347 with your credit card information handy.
RELEASE OF LIABILITY (required)
The undersigned, desiring to enter and participate in the Scooter and Supercar car show to be held Saturday, July 9, 2011, at the Petersen Automotive Museum, does hereby tender his/her application.
In consideration of the acceptance of this registration by the Petersen Automotive Museum Foundation (PAMF), the undersigned does hereby:
(1) release PAMF, its staff, directors, volunteers, and agents from any and all liability arising out of said event;
(2) release all other exhibitors and officials from any and all liability arising out of said event;
(3) warrant that the undersigned will abide by the rules and regulations of said event;
(4) give permission to use photographs and photos taken at the day of the event and information of entrant's automobile(s) for publication, program inclusion, or any other purposes.
I have read the above and accept the terms and conditions.
Owner (retype name): Date:
Exhibitor (retype name): Date:
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