Early Entry $40 {thru Sep 30} Event Day
Entry $45
Includes entry in prize drawing Not
eligible for early bird cash drawings
Name:
____________________________________________________________
Address: __________________________________________________________
City:
Phone:
__________________________ Email: ____________________________
Vehicle Year:
_______________ Make: ________________ Model: _____________
Color: _____________ Name
of Insurance Company: _________________________
Entrant’s Signature:
__________________________________________________
Send Entries
to:
Liability:
Entrants and participants by execution of this form,
release and discharge
Sponsors,
Volunteers, or anyone connected with the
known and unknown damages, injuries,
losses or claims, from any causes whatsoever that may be
suffered by participants to his person or
property. Emerald Coast Cruizin’ LLC has all rights
to this event.