Registration Form

Mail Entry Forms to:
The Southern Street Machine Association c/o Sandra Thacker 566 Netherton Drive Newport, Tn. 37821

REGISTRATION FORM
NAME:___________________________________________________________ PHONE:_____________________

ADDRESS:____________________________________________________________________________________

CITY:___________________________________________________________STATE:______ ZIP:__________

YEAR:__________MAKE:_________________________BODY STYLE:________________

LIABILITY Entrants and participants by execution of this entry form, release and discharge the State of Tennessee, City of Pigeon Forge, The Southern Street Machine Association, Godfather Customs, Shular Inn, thier officiers, directors, employees, representatives, servants and any one else connected with the presentation of the 12th Annual Godfather Customs Mini Truckin Nationals from any and all known or unknown damages, injuries, losses, judgements and/or claims from any causes whatsoever that may be suffered by an entrant or participant to this person or property.

TOTAL ENCLOSED:_______________SIGNATURE OF ENTRANT:___________________________________________

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