2005
JAMES DEAN RUN
OFFICIAL ENTRY APPLICATION
1970 or OLDER ONLY
TO: “JAMES DEAN RUN” PRE-ENTRY ENDS SEPT 1st
P.O. BOX 13 PRE-ENTRY FEE $15.00
FAIRMOUNT, IN 46928 GATE FEE $20.00
NAME
_____________________________________________________________________ DATE_________________
ADDRESS
____________________________________ CITY___________________ STATE______
ZIP______________
CLUB
AFFILIATION ________________________________________ SHIRT SIZE M L X XX XXX
MAKE
OF CAR _____________________________________________________________ YEAR __________________
MILES
DRIVEN TO RUN_______________________________
PLEASE READ AND SIGN
Complete and mail with $15.00 CHECK or MONEY ORDER to: “JAMES DEAN RUN”, P.O. BOX 13, FAIRMOUNT, IN 46928. A confirmation
of entry and official entry number will be furnished by return mail.
ENTRY
AND RELEASE: In consideration of this
entry, car owner, entrant and wife, just agree to permit the “JAMES DEAN RUN”
the use if their
names
and pictures of the car for publicity, advertising and commercial purposes
(including newspaper, magazines, radio and television) before, during
and
after the event and do hereby relinquish any rights whatsoever to any photos
taken in connection with the event and give permission to publish,
sell
or otherwise dispose of said photographs.
All publicity and advertising rights are reserved by the “JAMES DEAN
RUN”, in Fairmount.
LIABILITY: In consideration of the acceptance of the
right to participants and spectators, by execution of this entry from, RELEASE
and
DISCHARGE
Cluster Busters Hot Rod Club, Inc., Fairmount Historical Museum, Inc., “James
Dean Run”, Madison-Grant United School Corporation,
Town
of Fairmount, and their officers, directors, employees, agents, representatives, servants and anyone
else connected with management or
presentation
of the Tour of and from any and all known and unknown damages, injuries,
losses, judgments and/or claims form any cause whatsoever
that
may be suffered by any entrant to his person or property. Further, each entrant expressly agrees to
indemnify all of the foregoing entities,
forms,
persons and bodies of and from any and all liability occasioned or resulting
from the conduct of entrants or any participant assisting or
cooperating
with entrant under the direction or control of the entrant. We reserve the right to refuse any entry.
SIGNATURE
OF ENTRANT (and Guardian if under 18)
____________________________________________________
SIGNATURE
OF SPOUSE or OTHER ENTRANT
_________________________________________________________