Charlestown Police Reserves 

CAR SHOW & BURN OUT CONTEST

Sunday, August 12th, 2007 Clark 4-H Fairgrounds

State Road 62, Charlestown, Indiana

RODS, CUSTOMS & CLASSICS, TROPHIES, DASH PLAQUES, RAFFLES & CONCESSIONS - FUN FOR THE WHOLE FAMILY!

!!  WIN a 1956 four door OLDS Super 88 !!

 

 

FREE Spectator Admission

Car Show / Burn-Out Registration: $20.00 Donation (Date of Show)

Car Show  / Burn-Out Pre-Registration: $20.00 Donation

For Pre-Registering you will receive a Dash Plaque, T-Shirt & TWO chances to win a '56 Olds Super 88

(Check or money order received on or before July 25, 2007)

For more information, contact: Albert "Tubby" Purcell at (812) 987-6259 or at CPD549@aol.com

OFFICIAL CAR SHOW, BURN-OUT & VENDOR ENTRY FORM

Please Mail Completed Entry Form to: Car Show Entry, PO Box 632, Charlestown, Indiana 47111

(CIRCLE One)    CAR SHOW ENTRY    BURN-OUT ENTRY    VENDOR ENTRY    POLICE CRUISER

ENTRANTS NAME ___________________________________________ PHONE (_____) ______________

ADDRESS ___________________________ CITY ________________________ STATE _____ ZIP _____

CAR/TRUCK YEAR _______ MAKE ______________ COLOR ___________ BODY STYLE _______________

IF YOU ARE PRE-REGISTERING CIRCLE ONE:         LARGE        X-LARGE        XX-LARGE

CLUB AFFILIATION _____________________________________________________________________

LIABILITY: ENTRANTS AND PARTICIPANTS BY EXECUTION OF THIS ENTRY FORM HOLD THE STATE OF INDIANA, COUNTY OF CLARK, CITY OF CHARLESTOWN, THE CHARLESTOWN POLICE RESERVES, CLARK COUNTY 4-H ASSOCIATION, THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, REPRESENTATIVES, SERVANTS OR ANYONE ELSE CONNECTED WITH THE CHARLESTOWN POLICE RESERVES CAR SHOW AND BURN-OUT CONTEST, FROM ANY AND ALL KNOWN AND UNKNOWN DAMAGES INJURIES, LOSSES, JUDGMENTS AND/OR CLAIMS FROM ANY CAUSES WHATSOEVER THEY MAY HAVE SUFFERED BY ANY ENTRANT OR PARTICIPANT TO HIS PERSON OR PROPERTY.

 

ENTRANT’S SIGNATURE: _____________________________________________________ DATE: ______________

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