Name(s) ____________________________________________ Phone ________
Address ________________________________________ E-Mail ___________
City ___________________________ State____________ Zip ______________
YEAR MAKE MODEL
1st Car Entered _________________________________________________________
Included in Registration
Addional Car Entered _________________________________________________________
$8.00 each
_______300 Letter Car(s) ________Non-Letter Car(s) ________Other Mopar
GENERAL MEET REGISTRATION @ $25.00 per family $ ____________
(1st car included in registration)
Additional cars $8.00 each x ______ $ ____________
BANQUET: Saturday. August 29, 2009 includes coffee and dessert $30.00ea x ________ $ ____________
TOTAL AMOUNT ENCLOSED $ ____________
Mail Completed form and check payable to Chrysler 300 Club, Inc. to:
Doug Wright (Treasurer)
Chrysler 300 Club, Inc.
P.O. Box 241
Franklin, Idaho 83237-0241
Inquiries: Bruce Toelle 707-538-7430 gnspeedbird@aol.com
RELEASE FORM: I agree to insure my vehicle and property against loss, damage and liability. I agree to assume the risk of any and all damages of injury and to indemnify and hold harmless the Chrysler 300 Club, Inc., its officers, directors, agents and employees for any acts of omission which may result in the theft, damage, or destruction of my property or injury to me or others occurring during or as a consequence of this Meet, wherever located.