Roller Run Entry Form

September 7th, 2008

Name

 

Address

 

City                                                                       State                                           Zip

 

Phone  (                      )

 

E-mail

 

Year/Make/Model

 

 

Pre-Entry Forms MUST be received on or before August 25th, 2008

 

Completed Form & Fees should be mailed to Mansfield Parke, 7080 E Mansfield Rd, Mansfield, IN 47872

Circle One:

Antique (pre 1970)      Antique (1970 & up)        Street Rod        Street Machine        Corvettes

Truck (pre 1977)        Truck (977 & up)        Motorcycle        Rat Rod

I hereby release Hilltop Farm, JAM-Ty, Inc., Mansfield Parke, LLC and Mansfield Village from any responsibility for accidents, injury or damage that may occur during my participation in the 2008 Roller Run. It is understood that my vehicle may be used in promotional video or pictures of the event. The decision of the judges is final.

 

Signature                                                                                                                Date