First Name:

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Last Name:

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Car Club:

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Telephone:

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Cell Phone:

Email:

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Address:

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City:

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State:

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Zip Code:

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Make:

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Model / Series:

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Year:

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Body Style:

Car Club Corral: ($30 per car, includes admittance for two people)

Additional Admittance Tickets: (# tickets x $25/each in advance)

Release of Liability
The undersigned hereby releases the Desert Classic Concours d’Elegance and the La Quinta Resort and Club, its volunteers, committee, staff, sponsors, employees, ownership and all other participants, from any and all loss, liability or damage caused to the undersigned or their personal property, including claims of negligence, arising from said events to be held February 25 – February 28, 2010. The undersigned further agrees to carry full insurance coverage for all registered automobiles in the event(s) and to give permission to the Desert Classic Concours d’Elegance and the La Quinta Resort and Club for use of any and all photographs or other images taken during said events without restriction or compensation.

I have read the above and accept the terms and conditions.