Last Name ____________________________ First Name___________________________
City, State, Zip ______________________________________________________________
Phone (for questions) _________________________________________________________
Club Name and City __________________________________________________________
GRAND TOTAL SUBMITTED _$_______________________ CHECK #
To participate in any scheduled event, you must be registered. Please be aware that some events are limited to a certain number of participants and may not be available at a later date. We encourage everyone to make reservations as soon as possible, while plans are flexible and while an increase in the planned number of participants may yet be possible. I hereby release The Smoky Mountain Model A Club, and all participating members and individuals from any and all liabilities. No registration will be granted without the submittal of a signed registration form, which shall constitute acceptance of this release, signed on behalf of all family or guest participants, A cancellation fee of $25.00 will be charged after Sept 5,2014. This fee does not apply to vendors.
signed name____________________________ printed name_________________________________* Includes welcome party, tours and seminars.
** Includes dinner and entertainment, and door prizes.