All Wheels Weekend 2011 Registration Form

Address:____________________________________________________

City:_________________________ State:__________ Zip:__________

Phone:___________________________

Year:_______________________ Make:________________________

Model Car:___________________ or Model Pickup:________________

Color:________________________

Classification:______________________________________

Mileage to Dayton:__________________________________

Club Affiliation:_____________________________________

Number of Years Attended____________________________

Email Address______________________________________

NOTE: Full registration is for 2 people and 1 car only and includes
2 poker walk hands, 2 tickets to the demo derby, 2 Father's Day breakfasts,
dash plaque, entry in the Show-N-Shine, and a Roll the Dice ticket. 

Show & Shine entries receive a dash plaque and are judged for a
trophy, but do not receive entry to the demo derby or other events
during All Wheels Weekend without paying individual admission fees.
(*Dash plaques guaranteed to the first 350 entries.)

REGISTRATION FEES

• Early Bird Registration - Participants registered before May 25th will
  be entered in a drawing for a retro pedal car!
   
• Full Registration until June 6th - $35.00 $________
  No entry into drawing
  
  
• Full Registration after June 6th - $45.00 $________
  
  
• Show-N-Shine Only - $15.00 $________
  
  
• Additional person - $10.00 each  = $________

     (Club participants must be pre-registered by June 6th.)

I would like T-Shirts in sizes and/or hats as indicated:

ü  S  M  L  XL (circle one) - $15.00 $________

ü  XXL  XXXL (circle one) - $18.00 $________

ü   Embroidered Hat - $15.00 $___________

TOTAL DUE: $___________

Mail registration form and check made payable to:

All Wheels Weekend
166 E Main Street
Dayton, WA 99328

For more information call:
Dayton Chamber of Commerce _______All Wheels Weekend Chairperson
1-800-882-6299 ____________________Bette Lou Crothers: 509-382-4444
or chamber@historicdayton.com ________Bette.l.crothers.b7jm@statefarm.com

Registration packets can be picked up Friday night from 4 to 7 pm at First & Main or Saturday starting at 8 am in front of the State Farm Building on the corner of 1st and Main.

Operation: Event management reserves the right to restrict behavior of all entrants. No burn-offs, loud exhaust or sound systems. Any violation is reason for eviction. There will be no refund of money if a participant is evicted.

Liability: In consideration of your accepting my entry, I, intending to be legally bound for myself, my heirs, executors, and administrators, do hereby release and discharge the Dayton Chamber of Commerce, the All Wheels committee, all sponsors and supporters, and City of Dayton, Columbia County, and all other contributors from any and all liability arising from damages, illness, injury and/or physical consequences I may suffer as a result of my participation in this event. I understand that my entry fee is nonrefundable and that I must have proof of insurance. I have read the information provided and certify my compliance by my signature below.

Signature:____________________________________________ Date:___________

Registrations will not be accepted without a signature.