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ROUTE 66 ASSOCIATION OF MISSOURI
14th ANNUAL MOTOR TOUR : SEPTEMBER 5TH, 6TH, & 7TH, 2003
Registration Form (Please print or type & mail by August 30, 2003)
Name(s):____________________________________________________________
___________________________________________________________________
Email: ________________________________
Address: ____________________________________________________________
City:_________________________ State:_____ Zip (9 Digit):_____________
Phone:(____) ________
I / We will attend the Saturday dinner...Yes____ No____
Number____ @ $12.00 each $_______
Motor tour registration fee(s) enclosed....................
Number ____@ $25.00 per vehicle $_______
Grand Total amount enclosed for meals and tour registration fees....................................$_______
Make check payable to: ROUTE 66 ASSOCIATION OF MISSOURI
Mail To: Route 66 Association of Missouri - P.O. Box 8117 - St. Louis, MO 63108
WAIVER (Must be signed by all registrants)
The undersigned by signing below hereby agree(s) that the Route 66 Association of Missouri and/or its officers, directors, and representatives shall in no way be responsible or assume any liability, in whole or in part, for any loss, damage, injury to person or property, or any negligent act or omission resulting from, arising out of, or occurring at or during any activities, programs, tours, meetings, transportation, meals or other services and facilities furnished or supplied during and/or in conjunction with the Annual Motor Tour.
Signed: ___________________________
Date: _____________________
Signed: ____________________________
Date: _____________________
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Signed: ___________________________
Date: _____________________
Signed: ___________________________
Date: _____________________
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Thank You!
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