Thunder Road  Registration Form  ($25.00)
Name:
Address:
City:
State:
Zip:
Year & make of Car:
Club Affiliation:

Shirt Size MED. LG. XL. XXl. XXXL. (add $2 for XXL & XXXL)

E-mail Address:
Miles Driven To RUN:
(Not Responsible for Loss or Accidents)
NO ALCOHOLIC BEVERAGES ALLOWED)

Complete and mail with Check or Money Order to : The Rebel Run
Thunder Road
1505 Blair Rd.
Harrod, Oh. 45804
A confirmation of entry and official entry number will be furnished by return mail.
ENTRY AND ADVERTISING RELEASE: In consideration of this entry, car owner and guest agree to permit the THUNDER ROAD the use of their names and pictures of the car for publicity, advertising, and commercial purposes (including newspapers, 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 or sell or otherwise dispose of said photographs. All publicity and advertising rights reserved by THUNDER ROAD.

LIABILITY : In consideration of the acceptance of the right to participate, entrants, participants, and spectators, by execution of this entry form, release and discharge the THUNDER ROAD Allen County Fairgrounds, The City of Lima, State of Ohio, Allen County, and their officers, directors, employees, agents, representatives, and anyone else connected with the management or presentation of the show of and from any and all known or unknown damages, injuries, judgments, and/or claims from 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, firms, 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 director or control of the entrant. We reserve the right  to refuse any entry. ( Sorry, NO REFUNDS)

REQUIRED SIGNATURE OF ENTRANT (and Guardian if under 18)
X________________________________________________________________