John Burroughs Form

The John Burroughs High School 19th Annual Car Show

Please Fill Out Form, Print And Mail It To Us

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1 Make..

2 Model..

3 Year..

4 Calss #..

Vitals

1 Your Name......

2 Club Affiliation.

3 Address........

4 City.............

5 State........... 6 Postal Zip.....

7 Telephone...... 8 Facsimile......

9 E-mail.........

I Wish To Sponsor A 1st and 2nd place Merchant's Trophy For $ 60.00

I Wish To Sponsor A 1st place Merchant's Trophy For $ 30.00

Please Select Class Of Choice

100 Truck Stock	200 Truck Modified	300 Pre-1935 Open Modified
400 Pre-1935 Closed Modified	500 Pre 1948 Car Stock	600 1935-48 Car Modified
700 1949-59 Car Stock	800 1949-59 Car Modified	900 1960 -Present Car Stock
1000 1960-Present Car Modified	1100 Pre 1985 Motorcycle	1200 1985- Present Motorcycle
1300 Foreign Sports Car	1400 Domestic Sports Car	1500 Pro Street
1600 Race Or Competition	1700 Special Interest	1800 Muscle Car
1900 T-Bucket	2000 Under Construction Must Be Drivable.

We Want Pancake Breakfast ! # of for Breakfast Add $ 3.00 each

I Want Some Show Shirts Too @ 12.00 each #S #M #L #XL

#XXL add $ 2.00 Per Shirt

Liability Release: By execution of this form, I do hereby release and discharge the City of Burbank, Parks and Recreation Dept., J.B. Arrowhead Club Car Show Committee and John Burroughs High School and any members or employees thereof for any injuries to myself and all damages that may occur to my vehicle or vehicles while I am participating in the J.B. Arrowhead Club Car Show on Sunday, September 24, 2006 .

Signature ____________________________________ Date ____________________

Print out this form Make Checks Payable and send it to:

JB ARROWHEAD CLUB

P.O. Box 6692

Burbank, CA 91510-6692

For Information Call:

(818) 497-7198 or Send us an E-mail

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