Rock, Roll 'N' Rumble 2013 Car Show Registration Form
Name________________________________________________________________

Street Address________________________________________________________

City______________________________

State____________  Zip_____________________

Home Phone_______________________

Cell Phone_________________________

E-Mail_______________________________________________________________


Vehicle Information:

Year_______________

Make_________________________________

Model_________________________________

Color___________________

Special Info___________________________________________________________

____________________________________________________________________



Club Affiliation:________________________________________________________


In consideration of acceptance of the right to participate, entrants, participants and spectators, by the execution of this form, release and discharge Schwartzberg Communications, Inc/KNND Radio from any and all known and unknown damages, injuries, losses, judgement and/or claims from any causes whatsoever.  Schwartzberg Communications, Inc/KNND Radio reserves the right to refuse entry to any vehicle they deem unwarranted.


Signature_____________________________________________________________
                         Sign                                                                                                                            Date


Mail form with $20.00 Registration fee to KNND, 321 Main Street, Cottage Grove OR, 97424
Please make checks payable to KNND.