SCRAPE by the LAKE 2005

PRE-REGISTRATION

Name:_____________________________________ Age:______

Address:___________________________ City:______________

Prov/State:_____ Postal/Zip:_________ Email:______________

Club Affiliation:__________________Phone: ( ) __________

Vehicle: Year______ Make___________ Model ____________

(Circle all that apply) car truck suv lowrider bike hydraulics sportbike

Other Events (circle) car hop truck hop hydraulic/air dance

Pre-Registration – Show $30 (day of show $40) Lowrider Bike - $10

Deadline to pre-register : Friday August 12th

Make cheque/money order payable to: 1211861 ONTARIO INC.

And mail with this form to:

Scrape by the Lake

4696 Bartlett Rd. Suite #3

Beamsville, ON L0R 1B1

Approval: All entries are subject to approval by Scrape by the Lake staff. Entry fees (day of show): $40 per vehicle ($10 per lowrider bike) and are non-refundable unless entry is refused by SBTL staff. Liability: Scrape by the Lake, JW Sales, sponsors, Town of Lincoln, and Charles Daley Park assume no liability or responsibility for any theft or damage of vehicles, displays and related items during show hours. By signing below you acknowledge that you have current vehicle insurance that includes car show attendance. Safety: All hydraulic equipped vehicles must have proper disconnect kills, and a regulation fire extinguisher. All show vehicles may be moved into the show, to the judging lanes, and out of the show only. Park Damages: Entrants will be held responsible for any damages that may occur from the movement of said vehicle. Alcohol: No alcoholic beverages are permitted in the park and violators will be removed from the event. Photos/Videos: As a registered participant of Scrape by the Lake, you agree to the use of images and/or video of the above registered vehicle and/or person. These images/video will be used solely for the purpose of documentation, promotion and advertising for past/future Scrape by the Lake shows, and will not be sold/rented/loaned to any outside source for any reason. Information: As a registered participant of Scrape by the Lake, you agree to the use of the above registration information by Scrape by the Lake staff, for Scrape by the Lake events only. Above information will not be sold/rented/loaned to any outside source for any reason. As an entrant to the Scrape by the Lake Custom car show, I hereby agree to the above stipulations and regulations set forth. By signing below, I acknowledge that I have read and understood the above release, and understand my responsibilities. Pre-registrations are NON-refundable!

Signature_________________________Date_________Witness______________