Vehicle Registration Form

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The 5th Annual Care Show

Saturday, July 22, 2017
Registration 8:30 AM--10:00 AM
Car Show 10:00 AM--2:00 PM
Casa Grande High School, 333 Casa Grande Road, Petaluma, CA 94954

Registration Form (All Cars Welcome: $25.00 Entry Fee)

Liability: As a participant in The 5th Annual Care Show, I do hereby agree to release and discharge The Salvation Army,
its trustees, officers, employees, members, agents, volunteers and all other participants in this event from any and all
known and unknown damages, injuries, losses or claims to my vehicle, its occupants and myself. I give The Salvation
Army the right to photograph and keep all photos taken at this car show. I further acknowledge that all photos taken
will become the property of The Salvation Army and may be used in their publications.

Submission of this form and registration payments are indication of acceptance to the liability waiver above.

Name: ______________________________________ Email: _______________________________________

Mailing Address: ___________________________________________________________________________

City: _______________________ State: _______ Zip: __________ Phone #: ____________________________

Company Name: ___________________________________________________________________________

Company Address: __________________________________________________________________________

Amount Paid: ______________________________ Received by: _______________________ Date:________

Pre-register by phone or email today. Then complete and send your registration form with payment to The
Salvation Army, 721 South McDowell Blvd., Petaluma, CA 94954 by June 22nd. Check, cash (please do not
send cash by mail) or credit card payments accepted. Please make checks payable to The Salvation Army.

Proceeds from the Car Show will pay for new backpacks and school supplies for more than 100 needy
children in our community.

Credit Card Payment:

Card Number:___________________________ Name (as it appears on card):____________________________

Expiration Date:______________ Security Code/CVV:______________ Billing Zip Code:_______________

For more information, dont hesitate to contact Major Mitham Clement:

Phone: 707-769-0716 Email: mitham.clement@usw.salvationarmy.org