Jeffs 2015 entry form one side

Page 1

ENTRY FEE $30.00

ENTRY FEE INCLUDES A FREE T-SHIRT

ONLY ENTRIES POSTMARKED or POSTED ONLINE BEFORE DECEMBER 31st 2014 RECEIVE A FREE T-SHIRT

Please make all checks payable and send to: Pickups Limited of Orange County P.O. Box 4631 Anaheim, Ca 92803

Register online at: www.jeffsfunrun.com

ALL CONFIRMATIONS WILL BE SENT VIA E-MAIL

Event Starting Time - 8:30am Ken Grody Ford %HDFK %OYG ‡ %XHQD 3DUN &$ )UHHZD\ H[LW DW %HDFK %OYG 1RUWK WR &RPPRQZHDOWK ‡ ZZZ NHQJURG\IRUG FRP

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OPEN TO ALL MAKES, MODELS, AND YEARS OF VEHICLES

Saturday January 17 , 2015 th

The Poker Run Begins at 8:30am - Rain or Shine - OVER 200 VEHICLES • www.jeffsfunrun.com

ENTRY FORM: Name:____________________________________________ Address: __________________________________________ City: ___________________ State: _______ ZIP: _________ Area Code: ________ Phone: _________________________ E-Mail: ____________________________________________ CONFIRMATIONS WILL BE SENT VIA E-MAIL

VEHICLE INFORMATION Make: __________ Model: ______________ Year: ________ Club Afiliation: _____________________________________

ORDER FORM: Standard Entry Fee - INCLUDES FREE EVENT SHIRT BEFORE DECEMBER 31st 2014 $30 = $________ select your FREE shirt when you enter before December 31st

S___ M ___ L ___ XL___ XXL___ XXXL___

Order Additional Short Sleeve Event T-Shirts S___ M ___ L ___ XL___ XXL___ XXXL___ I would love to attend but can’t make it. For an additional $8, please mail my shirt at the address on this form. A LIMITED NUMBER OF EVENT SHIRTS WILL BE AVAILABLE THE DAY OF THE RUN

______ @ $20 = $________ $8 POSTAGE = $________

TOTAL $________

PUBLICATION & LIABILITY RELEASE: I hereby consent to the use and publication of any photos in which I or my vehicle may appear, either intentionally or unintentionally in whole or in part. I understand that all photographs are the sole property of Pickups Limited of Orange County and their assignees. Entrants and participants by execution of this entry form, release and hold harmless Pickups Limited of Orange County, Ken Grody Ford, any Vendors, DJ's, Bands and Food Vendors, their officers, directors, employees, agents representatives, and anyone connected with the presentation of the Jeff’s Fun Run from any known and unknown damages, injuries, losses, judgments, or claims from any causes what-so-ever that may be suffered by any entrants or participant to his person and property.

NO LOUD MUSIC, ALCOHOL, RACING OF MOTORS, BURNOUTS, BBQ'S OR OPEN FIRES IN THE SHOW AREA

I HAVE READ AND UNDERSTAND THIS FORM AND WILL ABIDE BY ALL RULES AND STATED RESTRICTIONS SIGNATURE: ____________________________________________________ DATE: _______________________________ Register on at www.jeffsfunrun.com via Pay Pal or Credit Card For more information contact: funrun@pickupslimited.com or call (657) 464-3115


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