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Registration Form
Name:_________________________ Accompanied
by:_________________________
Address:________________________________________________________________
Phone:_________________________
email:__________________________________
Club Affiliation:___________________________________________________________
Any Special Dietary Needs:__________________________________________________
Want to donate a Door Prize? N__ Y (what)____________________________________
Number of People going on Hyundai Semiconductor Plant Tour_______________________
| Vehicle(s) Entered | |||||||
| Year | Model | Body Style | Color | HP | Trans. | Plate # | Show&Shine? |
Yes___ No___ |
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Yes___ No___ |
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Yes___ No___ |
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I, ______________________, hereby release and agree to hold harmless the Beaver State Corvair Club and its individual members, the Corvair Society of America, and the DoubleTree Hotel during the course of this Econorun.
| Number of vehicles entered: _________ | x $10.00 = | $ |
| Number of Prime Rib dinners: _________ | x $24.00 = | $ |
| Number of Grilled Salmon dinners: __________ | x $24.00 = | $ |
| Number of tee-shirts: S___ M___ L___ XL___ | x $12.50 = | $ |
| Number of tee-shirts: XXL___ XXXL___ | x $13.50 = | $ |
| Total | $ | |
|
| Mail this form by April 7th, along with your check (made out to Beaver State Corvair Club) to: |
| Charles Morgan |
| 1772 Happy Lane |
| Eugene, OR 97401 |