D & D Rockin’ Rods Registration Form
NAME: _____________________ADDRESS:
____________________________
CITY, ZIP: __________________ PHONE: ( ) __________________________
MAKE/MODEL: _____________YEAR: _______ COLOR: _____________
CLUB: ______________________________
Circle One Below:
Under-Construction Special Interest Cycle Truck Car
E-Mail
Address: ____________________________________________________
NOTICE: D & D Rockin’ Rods, Sponsor(s) &/or
Co-Sponsor(s) are not responsible/liable for loss, damage or injury to any
person, vehicle or equipment during this event.
Signed: _________________________________________ Date:
__________
Please
return this completed & signed form
with your entry fee at the registration table.
You will receive your vehicle number at that time. Thanks, D & D Rockin’ Rods
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www.DDrockinRods.com