Full Name                                                                        Screen Name                                              
Address                                                                      Phone                                                
                                                                                      Email                                    
                  
Vehicle make, model year                                                              Color                           
Tag Number                                                                     
Insurance Company Name: _____________________________
Insurance Policy Number: ______________________________                                                           

Waiver of Liability

I hereby confirm my guests and I are all 18 years of age or older, unless they are my children or I am their legal guardian. I understand I will be responsible for my own actions and will conduct myself in a civilized manner at all times during this event. I understand the possible driving hazards associated with the roads related to this event, and hold harmless the organizers and sponsors from any and all liabilities before, after and during this event. I further understand this is NOT a sanctioned event and that I am entirely responsible for the behavior and well being of both myself, and those accompanying me.

YOUR NAME, SIGNATURE AND NAME OF EVERY PERSON IN YOUR PARTY:

Name                                                                         Signature                                                                       

Guest                                                                            
      
Guest                                                                                                                     

Guest                                                                            

Guest                                                                            

Guest