NAME________________________________________________ ADDRESS_______________________________________________ CITY____________________ STATE_______ ZIP_____________ PHONE ______________________ E-MAIL________________________________ VEHICLE: YEAR ________ MODEL _____________ COLOR _____________ AMOUNT ENCLOSED $ _______________ I ________________________________ RELEASE EAST END CRUISERS, JIM & PATTI PETERS AND COWLITZ RIVER LODGE FROM ANY LIABILITIES OCCURRING TO MYSELF OR ANY PERSON AND/OR VEHICLES WHILE ATTENDING THIS EVENT. SIGNATURE OF ENTRANT _________________________ DATE _____________