NAME:

ADDRESS:

CITY:

STATE:

ZIP CODE:

EMAIL:

PHONE:


ABOUT YOU:        Note: All fields are required unless otherwise noted.
ABOUT YOUR RIDE:
PAYMENT OPTION / SUBMIT FORM:  (Note: this just tells us how you plan to pay.  You must click the box below to agree
to the terms and then click the submit button.  You will then be taken to the payment page)
PAYMENT OPTION SELECTED:
RELEASE TERMS:

THE ABOVESIGNED (checkbox acknowledgement), in consideration of acceptance to participate in the July 20, 2019 “Cruisin in Coatesville Car Show and Street Fair” (the “Event”) hosted by the Coatesville Downtown Revitalization, Inc., (the “Committee”), hereby fully releases and holds harmless the Cruisin in Coatesville Car Show Committee, the Town of Coatesville, and the Committees and town's respective officers, directors, members, agents, representatives, guests, and volunteers from all claims for bodily injury to myself or my vehicle, or indirect incidents to my participation (show car participant or vendor participant) in the Event.

THE ABOVESIGNED, fully understands that the terms of the Full Release shall serve as a full release and full assumption of risks of my vehicle, my property, myself, my heirs, executors and administrators, and for all persons authorized by me accompanying me to the Event.

THE ABOVESIGNED, hereby attests and verifies that I am lawfully licensed to operate a motor vehicle in the State of Indiana, (or the State I reside in,) and I possess liability insurance to cover bodily injury or property damage that might arise from either my participation in the Event, or in participation of those authorized by me to so participate in the Event. I am aware of the risks involved in the participation of the Event, and fully assume such risks for myself, my business and/or my authorized representatives.

THE ABOVESIGNED, fully understands and agrees that photographs, pictures, slides, movies, or videos may be taken in connection with my participation in the event or activity without compensation from the Town of Coatesville or the Committee and consents to the use of photographs, pictures, slides, movies, or videos for any legal purpose. 

I HAVE READ THE FULL RELEASE FORM, UNDERSTAND IT’S TERMS, AND ACKNOWLEDGE THAT WITHOUT MY ACCEPTANCE, I WILL NOT BE PERMITTED TO PARTICIPATE IN THE EVENT. I WARRANT THAT I AM IN GOOD HEALTH AND HAVE NO PHYSICAL CONDITION THAT WOULD PREVENT ME FROM PARTICIPATION IN THE EVENT OR ASSOCIATED EVENT ACTIVITIES. 

THE ABOVESIGNED, hereby accepts all of the terms of the Full Release, as evidenced by my signature above.
CATEGORY:

YEAR:

MAKE:

MODEL:

ANY SPECIAL FEATURES ABOUT YOUR VEHICLE:

CLUB AFFILIATION:

T-SHIRT SIZE:  (NOTE: T-shirts to the first 100, however, a pre-registration does guarantee you a t-shirt as long as you
register by June 20th.  After June 20th, there is no shirt guarantee.  If we have any left, it will be an XL.)
ON-LINE REGISTRATION

Complete the form below and click the "SUBMIT" button to go to the payment page. When completing the form, you will be asked if you want to pay online or by a check.  After submitting the form, the following page will give you the option to pay immediately via Paypal.  If mailing a check, the following page will have all information on how to complete your check and where to mail it.

NOTE:
Online registration closes on July 5th at midnight for payments via check and on July 12th at midnight for online/Paypal payments.  There will be no online registration available the week prior to the car show.  This is done to so we have time to prepare windsheild placards and so we can attempt to get together the other benefit items if at all possible for registrations that were made after June 20th.
CarMotorcycleTractorTruck
Small
Medium
Large
X-Large
2XL
3XL
Paypal (Paying Now)
Check (Mailing Check.  Check must be received within 10 days of your registration)
  By selecting, I acknowldge that I have read, understand, and agree to the release terms listed below including the Rain Refund Guarantee terms.