Pre-registration $30.00 ( pre-registration ends May 13,
2011 )
Day of Show $40.00
Name: ________________________________________________________________________________________________________
Address:___________________________________ City :________________________ State: ________
Zip Code: _________
Year and Make Of Vehicle :______________________________ Model : _______________
Insurance:_______________________
Club: ________________________________ E-Mail: _____________________________
Burn Out: Yes ______ No: _______
Entrants and participants by the execution of this form, release
and discharge the State of La, and Ms. The River City Bad Boyz, Inc. the Comfort Suites, the City of Vidalia,
La, and the River Park from any and all known and unknown damages, injuries, losses, judgements and or claims whatsoever that
may be suffered by any entrant or participant to his or her person or property.
Signature: ____________________________________________________
Date: _________________________________
Make Checks payable to River City Bad Boyz - P.O. Box 692 - Vidalia, La 71373
www.rivercitybadboyz.com
