Callaway Vintage Tractor Drive

August 29, 2009

registration form

Please Print

                                                                Please keep all riders off of fenders.

                                                               

                                                             

Name  ___________________________________________________________________      Date of    Birth____________

How Your Name Should Appear on Name Tag: __________________________________________________________________     

Address________________________________________________________________________________

City  _________________________________________ State  _______Zip_________________________

Home Phone____________________ Work Phone ___________________Cell Phone_________________

Email__________________________________________________________________________________

Tractor Manufacturer______________________________Model______________________Year_________

                                                               Please keep all riders off of fenders

In consideration of your acceptance of this entry, I hereby, for myself, my heirs, my executors, administrators, waive all rights and claims for damage I may have against individuals associated with this event, its agencies, representatives, successors and assigns, for any and all injuries suffered by me in the Callaway Vintage Tractor Drive. I attest and verify that I have full knowledge of the risks involved in this event and am physically able and sufficiently trained to participate in the event. I also attest that I have liability insurance. I understand that the Callaway Vintage Tractor Drive organizing committee and/or law enforcement officials reserve the right to limit the number of tractors in the ride in order to control traffic and other administrative tasks. I give my permission for the use of my name and picture in any broadcast, telecast, DVD or print media account of the Callaway Vintage Tractor Drive.

Signature _____________________________________ _____________ Date____________________________

Parent or Guardian Signature

is also required for participants under 18.      _____________________________________________________________

                                                                                                                                   parent or guardian signature

Early registration $30.00 per tractor  $40.00 on the day of the drive

Profits from this event go to support the programs of the Callaway County Historical Society

                                                                                                                         

                                                                                     Make checks payable to Callaway Vintage Tractor Drive                                                                                                                        

for more information contact:                                                        Send registration and check to:                                                                                                                                                                                                                                                                 

Mike Boulware………..573-387-4454                   Callaway Vintage Tractor Drive           Kingdom of Callaway Historical Society

Joe Spatafora…………573-642-3842                    Mike Boulware                                 513 Court Street

Lewis Baumgartner…..573-642-1183                    1154  County Rd. 283                      PO Box 6073

John Feltner…………..573-642-5296                    Auxvasse, MO 65231                       Fulton, MO 65251

Dan Tucker…………...573-642-5190

Print this page for your registration form

I will have a dvd available.