JMWT Car & Motorcycle Show FundraiserVehicle Registration FormPage 2

Car Show Registration forms must be received by April 28, 2017

Owners Name:

Street Address:

City:State:Zip:

Phone:Email:

Make:Model:Year:

Club Affiliation (if any):

CLASS:

Registration:

[]Preregistration– Cars/Trucks$15(Day-of Registration: Add $5**)

[]Pregregistration– Motorcycles$15(Day-of Registrations: Add $5**)

ALL REGISTRATION FEES ARE CHARITABLE DONATIONS AND ARE NON-REFUNDABLE
(** subject to space availability)

Make Checks payable to:JM Wright Tech PFO

Mail to: Car Show *120 Bridge Street * Stamford, CT 06905

Owner Driver License NumberStateExpiration Date

Vehicle Registration NumberStateExpiration Date

Insurance CompanyPolicy NumberExpiration Date

*** In order to participate in the JM Wright Tech Car & Motorcycle show, all vehicles owners must show each of the following documents upon arrival:

  • Driver’s license
  • Vehicleregistration
  • Proofof valid insurance.

REQUIRED WAIVER OF LIABILITY, RELEASE, AND PAYMENT INFORMATION

On behalf of the entire group participating in the 2017 JM Wright Tech Car & Motorcycle Show Fundraiser, I assume all risk of bodily injury, property damage, and personal damage that may occur by participating in the JM Wright Tech Car & Motorcycle Show Fundraiser, and, for myself/ourselves, my heirs, executors, and administrators, do hereby forever waive and release any and all claims against and agree to hold harmless the JM Wright Tech PFO and the JM Wright Tech Car & Motorcycle Show Fundraiser. It’s committee, sponsors, and volunteers, and the City of Stamford, the State of CT, JM Wright Technical High School with their respective officers, employees, agents, representatives, volunteers, successors or assigns any kind of any and all claims which any be made for any cause whatsoever arising as a result of participation. Further, I hereby consent to allow my picture or likeness to appear in any official document, news release, sponsor advertisement and/or television/radio/internet coverage of the events within or as part of the JM Wright Tech Car & Motorcycle Show, and grant permission to use and/or publish photographic portraits, or pictures, video tape or film of me in which I may be included in whole, part, composite or reproductions thereof in black and white and/or color or otherwise made through any media now know, for art, advertising trade, or any other similar lawful purposes whatsoever, including the publicity and promotion of this event itself, excluding commercial use of or by marketing sponsors.

By signing this I state that all information is true and accurate and I agree to all of the terms and conditions stated herein.

Print Name:

Registrants SignatureDate

Questions? Contact us at

Tel: 203-231-1035

JM Wright Tech PFO, a non-profit 501(c)3 organization Fed ID: 47-2190501