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Mt. Lake Fire Company

2016 Pre-Registration Auto Show Form

Pre-Registartion dealine:  June  1st 2016

Pre-Registration Fee- $10.00: Day of Show Registration- $20.00

Pre- Registration Benefits:

Guaranteed parking spots for pre-registered vehicles arriving prior to 9am on

Sunday July 31st     A picture of your vehicle is required at registration

Pre-Registration attendance plaque

Event is rain or shine, No registration fee refunds

PLEASE PRINT

Name:____________________________________________________________________

Mailing Address  :__________________________________________________________

City:________________________________State:_________________Zip:_____________

Email:____________________________________Phone:___________________________

Type of Vehicle:   Street Rod, Truck, Bike, Car, Jeep, Etc._____________________________

Make, Model:_________________________________________________________

Year:________________Color________________        _Modified:        Yes   or No

Car Club Name:______________________________________________________________

Liability Waiver: With this right to participate, I hereby release Mt. Lake Fire Co. & Township of Liberty , Sponsors and all others who

may be concerned , from any liability of injury or losses to myself and/or family during the event on July 31st 2016. I also consent to

the free use of my name, my likeness and image for any purpose whatsoever.

                Signature of Entrant:_______________________________          Date:  ________________          

                Make Checks payable to : Mountain Lake Fire Company   (MLFC)

                (A $25.00 fee will be added to all returned checks)

 

Forms must be received on or before June 1st 2016:  Mt. Lake Fire Co. 99 Tamarack Rd. Belvidere, NJ 07823