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Name____________________________________________________    Phone__________________________     


Email____________________________________________________   


Address    ____________________________________________________    City    __________________________   


State   __________________________    Zip    __________________________


Car Club affiliation   __________________________________________________________   



Number of vehicles __________________   at $15.00 each        Total:  __$__________________________

Additional (*optional) donation amount                                               __$__________________________

Total Amount                                                                                    __$_________________________



Vehicle #1:

Make    __________________________    Model     __________________________   


Year    __________________________    Preferred Class    __________________________


Display only (not judged) Y/N    __________________________   


Vehicle #2:

Make    __________________________    Model     __________________________   


Year    __________________________    Preferred Class    __________________________


Display only (not judged) Y/N    __________________________   




_________    I am interested in volunteering as a show judge.


By completing this registration and participating in this event, the undersigned, or agent, agrees to HOLD HARMLESS the National Parkinson Foundation Ohio, Quaker Steak & Lube, any of its representatives, agents or volunteers affiliated with the production of this event, for any injuries or damages which may incur while participating in this event.  Any and all photographs, still or moving, taken by the National Parkinson Foundation Ohio, any of its representatives, agents or volunteers affiliated with the production of this event becomes the sole property of National Parkinson Foundation Ohio and may be used for future advertising or promotions.


Signed                                                                                                                                                                  Date


For preregistration please return this form and registration fee before August 16th to:

National Parkinson Foundation Ohio

2800 Corporate Exchange Dr.

Suite 265

Columbus, OH 43231