PICNIC ENTRY FORM

16th PICNIC ENTRY APPLICATION

Send to: P.O.Box 131 Berwick 3806 Tel 03 9796 2251

Name.............................................Е Address.........................................................................ЕЕЕЕ.

Year & Make of Vehicle ............................................................................... TelЕЕЕЕЕЕЕЕ.....

Reg.........ЕЕ..... TypeЕ.............ЕЕЕ........................... Colour................................

Mods ...........................................................................................Е...........................................................

CAR ENTRY FEES:

Weekend Family* Car Entry (*2 adults & 2 children under 14).................... $40.00 $............Е

Weekend Driver (NOTE: Buddy passes $10.00 per day, $20.00 w/end)...... $30.00 $............Е

Saturday Only: Family* ..... $20.00 ........ Driver..... $15.00 ....................................... $................

Sunday Only: Family* ..... $35.00 ........ Driver..... $25.00 .......................................... $............Е

Yes, I want ............ T\shirts, sizes................Е...................................... @ $18.00 ea. $............Е

(No Dogs Allowed) Total $________

We agree to release JohnТs Rod & Custom, Kustoms of Australia, their agents, associates, Pakenham Racecourse Committee, and everyone connected with the event, from all and any liabilities in regards to damages, injuries, or losses to ourselves and/or our property, arising in relation with this event. We authorise KOA and their agents to take and use images of ourselves and/or our cars in promotions, publications, DVDТs etc. Attendance of the event confirms acceptance of the above terms.

Signed................................Е... Date............ЕЕ..