50's CRUZ-IN at the Lake
Registration Form
September 15, 2005
Presented by Detroit Lake Recreation Area Business Association

Name:  
E-Mail Address:  
Address:  
City:  
State:  
Make:  
Model:  
Year:  
Club Affiliation:  

Select Class of Entry, Please check one.
   Custom___:   Original___:   Custom Pickup___:  Original Pickup___:   
   Street Rod___   Custom Motorcycle___:    Stock Motorcycle___:

LIABILITY: In consideration of the acceptance of the right to participate, entrants, participants, and spectators, by execution of this entry form, release the city of Detroit and their officers, directors, employees, agents, representatives and servants, and anyone else connected with management or presentation of the 50'S CRUZ-IN AT THE LAKE of and from any and all known and unknown damages, injuries, losses, judgments, and/or claims from any cause whatsoever that may be suffered by any entrant to his person or property.  Further, each entrant expressly agrees to indemnity all of the foregoing entities, firms, person and bodies of and from any and all liability occasioned or resulting from the conduct of entrants or any participant assisting or cooperating with entrant under the direction or control of entrant.
Registrant Signature is Required

Signature:   Date:  
Send $10.00 Check or Money Order Payable to:
D.L.R.A.B.A.
P.O. Box 574
Detroit, Oregon.  97342

For Official Use Only

Entry Number