Registration Form - Provincial Exhibition Of Manitoba

REGISTRATION FORM

Super Run Manitoba

July 29, 30, 31 2016

Keystone Centre, Brandon Manitoba

Open to any Make and Model 1983 & Earlier

Name:__________________________________________________________________________

Spouse/Guests (

):______________________________________

children under 12 requiring Banquet tickers

Guests(

):______________________________________________________

including children 13 & over

Address: ________________________________________________________________________

City: ____________________ Prov/State: ________ Postal Code/Zip: ____________________

Phone: _______________ Fax:__________ Email: ____________________________________

Vehicle: Year:__________ Make:_______________ Model: ______________________________

2nd Vehicle: Year: __________ Make: ______________ Model: ___________________________

Club affiliation (No affiliation necessary): _____________________________________________

Young Gun (under 18 years of age):

Yes:_____

No:_____

Limited to 1000 entries

All registrations received before May 1, 2016 will be reduced to $90.00

 Registration Fee (includes 2 Adult admission, Banquet tickets,

Meet & Greet tickets, Banquet Tickets for children under 12) ____ @ $100.00/car

= $ _____________

 Additional Banquet Tickets for Guests & Children 13 & over ____ @ $35.00 each

= $ ______________

 Entry for a second vehicle (no extra tickets) __________________ @ $25.00/car

= $ ______________

 One day Registration (includes 2 Adult admissions only) ________ @ $25.00/car

= $ ______________

Subtotal

= $ ______________

5% GST

= $ ______________

Cheques/Money Orders made out to: Provincial Exhibition of Manitoba

TOTAL

= $ ______________

*** Additional Banquet tickets may be purchased at the event, if available, at a cost of $40.00 each.***

THERE WILL BE NO REFUNDS ON FEES!

Privacy: In respect of the privacy laws, Super Run Manitoba and the Provincial Exhibition of Manitoba will keep all information

on this form in the strictest confidence, and will not release, trade or sell any information to anyone at any time for any purpose.



Check this box if you DO NOT want your name or vehicle used on our website or in materials used to advertise and pro-

mote this event or future events.

In consideration of the Provincial Exhibition of Manitoba , holding a car show, in Brandon, Manitoba on July 29, 30, 31, 2016 I/we the undersigned do hereby release, indemni-

ty and agree to save harmless the releasees their heirs and executors, administrators and assigns, from all actions, causes of action, damages, claims and demands whatsoever

which we have had, not have or which I/we, our heirs, executors, administrators, or assigns hereafter may have against the releasees by reason of, or arising out of our participat-

ing in the said car show. We understand that while every precaution is being taken by the releasee to prevent injury and damage to the participants, I/we could be injured.

I/we have read over the above release and indemnity agreement and we understand that it is a full and final release of all claims for damages or injuries that may be sustained as

a result or our participating in the event, whether such damages or injuries are known or not yet ascertained at the present time.

If under 18 years of age, parent or legal guardian must sign this form.

In witness whereof we have set our hands and seals, this ______ day of ___________________2016

Signature: _____________________________________________Date: ____________________________

Please return this registration form with your full payment to:

Provincial Exhibition of Manitoba Attention: Super Run Manitoba 2016

115—10th St, Brandon, MB R7A 4E7

For more information: call 204-726-3590 or E-mail:

Or visit our website at