Flint Hills Steam Car Tour  (Click to return to home page)                            Registration Deadline is March 31, 2010

To register: copy and print the form.  Mail to the address listed below.    

 

Registration Form

 

2010 Kansas Flint Hills Steam Car Tour

Manhattan, Kansas      May 17-21, 2010

 

Please print or type. Thank you.

 

TOUR CAR INFORMATION:            Make: _________________ Model: ________________ Year: __________

 

                                                                 H.P.: _____________ What type of fuel used: ________________________

 

Driver’s First Name: ________________________________ Last Name: _________________________________

 

Your “go-by name” for the Badge if different: _______________________________________________________

 

Street Address: _______________________________________ /or P.O. Address: __________________________

 

City: ________________________ State/Country: _________ Zip/Postal Code: ____________ Country: ________

 

Tel/Work: ______-_____-________ Tel/Home: _____-_____-________ Cell: _____-_____-________

 

E-mail Address: _____________________________________________________________________

 

Please print or type the names of other members in your party:

                                                                                                                        The “go-by name” for the Badge if

First Name                                           Last Name                                                different

 

_________________________            _________________________            ______________________________

 

_________________________            _________________________            ______________________________

 

_________________________            _________________________            ______________________________

 

_________________________            _________________________            ______________________________

 

_________________________            _________________________            ______________________________

 

_________________________            _________________________            ______________________________

 

_________________________            _________________________            ______________________________

 

I (and my party, if applicable) will participate in this year’s Kansas Flint Hills Steam Car tour, and agree to indemnify, defend, and hold harmless the organizers of this event from and against any and all claims, costs, liabilities, and attorney’s fees arising from damage or injury, actual or claimed, of any kind or nature, to property or persons resulting from my/our participation in this tour. I further confirm that the automobile herein registered is in road-worthy condition as required by the highway regulations of the state or country in which it is registered and licensed and that it is insured for Bodily Injury and Property Damage Liability. (Please have a copy of your insurance policy with you on the tour.) I further confirm that my touring vehicle will have a fire extinguisher on board at all times.

 

 

SIGNATURE: __________________________________________________ Date: _________________________