5TH ANNUAL CAR & BIKE SHOW

October 9th, 2010

9:00 A.M. – 4:00 P.M.

Hotrods          Antiques     Motorcycles

Dale Ruritan Club

Richmond Va.

Rt. 10 and Chippenham Parkway

 

ALL PROCEEDS TO BENEFIT

SHELTERING ARMS HOSPITAL

 

Dash plaques for first 100 registered.

         Best and Top 10 for Modified & Antiques. Top five and best for                bikes. Top five and daily driver for stock cars. Also, longest

distance, lady’s choice, & best club participation.  

Activities for children

50-50 Drawing, door prizes, food, music

Contact:      804-383-2961

www.3000daysafetyclub.com

 

 

 

Register using the form below. Pre- registration fee is $15.00 per car and must be

received by October 8th.  Registration will not be processed until payment is received.

Registration day of show is $20.00. General admission is $3.00 per person

(12 years and under free). Checks should be made to 3000 Day Safety Club.

Best and top 10 for modified, and antique. Three alterations will put you in modified class.

Top five and best for bikes. Top five and daily driver for stock cars. Also, longest distance,

Lady’s choice & best club participation. No refunds.

 

PRINT A COPY OF THIS FORM AND MAIL TO:

 

 Dupont Machine Shop

P.O. Box 27001

Richmond Va. 23261

.

Name*______________________________

Street Address*_______________________

Address (cont.) ________________________

City*________________________________

State*____________________                     

Zip code*________________                       

Home Phone______________                      

E-Mail___________________                      

    Car /truck/Motorcycle Type/*_______________

           Modified/Antique/Stock*______________________

     Year of Vehicle*_________                                 

     Club* _____________                                         

                                    Distance* _______                                                                            

                                                      New Participant*_______                                                                                       

                                 * Required fields                                                                                  

 

           

Waiver of Liability

In consideration of the acceptance of the right to participate, entrants, participants, and spectators

                      by execution of this form, expressly release and discharge E.I DuPont Inc., DuPont 3000 Day                    Safety Club, Dale Ruritan Club and it’s officers, directors, employees, agents,

      representatives, and servants, and anyone else connected with management or presentation

of E.I. DuPont Inc., DuPont 3000 Day Safety Club, Dale Ruritan Club of and from any and all known

or unknown damages, injuries, losses, judgments, and/or claims from any causes whatsoever that may be

suffered by any entrant to his/her property. Further each entrant expressly agrees to indemnify all of the

forgoing entitles, firms, persons and bodies from any and all liability occasioned or resulting from

conduct of entrants or any participants assisting or cooperating with the entrant and under the direction or

control of the entrant. E. I. DuPont Inc., Dupont 3000 Day Safety Club, and Dale Ruritan Club.

Please do your part by observing all safety and traffic regulations, safety rules, fire ordinances,

and maintain good conduct. NO alcoholic beverages please.

 

 

Signature: _____________________________________________________