ARIZONA REGIONAL MEDICAL CENTER CUSTOM CLASSIC CAR SHOW

2050 W. Southern Ave    West of Ironwood    Apache Junction, Az.

Saturday   November 19th   9:00am-1:00pm

Prizes awarded for 1st & 2nd place in each class *Best in show* People's Choice*

Car Show is a Benefit to raise money to provide uninsured or underinsured Apache Junction residents the opportunity to have a free mammogram.

100% of Entry fee will be a donation to *Breast Assured

* non profit mammography service providing mammography's for uninsured & underinsured women & men in the Apache Junction community

Registration Please fill out all information!
Name:
Address:
City:
Zip:
Phone:
Email:
Car Make:
Model:
Car Year:
Liability Release: In consideration of the right to participate, entrants, participants and spectators by execution of this form, release and discharge ARMC, City of Apache Junction, members of presenting clubs and associations, Any Merchants and their Officers, Directors, Employees, Agents or Representatives and anyone connected with the Car Show of any known or unknown damages, injuries, losses, claims from any cause whatsoever that maybe suffered by the entrant to their person or property. Entrants will also indemnify all for going entries, firms, persons of and from any liability resulting from the conduct of any entrants or participants. Submittal of entry serves as signature, acknowledgement, full understanding and agreement to liability release.