REGISTRATION FORM

REGISTRATION FORM
WSU Car Show
1845 Fairmount, Box 91
Attn: Gayle
Wichita, KS 67260-0091

Best of Show

President’s Choice

First Lady’s Choice

Top 25

Certificates Awarded For:

Club Participation

Most Unique

Best Non-motorized vehicle

Best Emergency Vehicle

Best Competition

Best Work in Progress

Best WSU Employee Vehicle

Last Name: _______________________ First Name: _______________________
Street Address: _____________________________________________________
City: __________________________ State: _____ Zip: _____________________
Phone: __________________ E-mail address: _____________________________
Year: ______ Make: ___________________ Model: ________________________
Color: ____________ Club Affiliation(s): _________________________________

Method of Payment (choose one): ______ Check ______ Money Order
______ Cash (in person only please)

Please make check/money order payable to: WSU Foundation Car Show

Remit to: WSU Car Show, 1845 Fairmount, Box 91,

Attn: Gayle, Wichita, KS 67260-0091

In consideration of and to permit my participation by showing one or more vehicles in the WSU Car show to be held on the campus of Wichita State University on Sunday, September 13, 2009, I hereby acknowledge and accept the risk of possible personal injury resulting from or caused by my participation in the Car Show, and I hereby acknowledge and affirm my continued willingness and desire to participate. Further, and of my own free consent and volition, and in consideration of my participation in the Car Show, I hereby agree to indemnify and hold harmless Wichita State University, its administrators and employees, and to waive claims for any and all injuries, causes of action, or damages that I or my vehicles may sustain while participating in the Show. By signing below, I acknowledge that I have read and understood this waiver and release of liability and that I am signing it voluntarily.

Signature: _______________________________ Date: ____________________

Proceeds donated to the Midian Shrine Plane of Mercy Fund which provides monetary and
transportation assistance for children in need of medical care and the families across the country.