Concord Mall Car Show

Hosted By:
The Familia Car Club

We are not just a club, we are Family

TM
2017 Car Show ENTRY Form
Date: Saturday June 17, 2017
Location: 3701 South Main Street, Elkhart, IN 46517
Event Hours: 1:30pm 11:00pm
Prime Leasing & Sponsorship Deborah Alwine .
Prime Host Jorge Millan
Car show registration forms must be received by
Your Contact (Please print clearly ) June 2, 2017

Name

Car Club (if attending with a car club)

Phone Mobile Phone

Vehicle Year Make Model

Registration One form per vehicle. Car clubs: Please combine all your entry forms into one submission.
Approximately half of each entry fee goes to community nonprofit organizations.
Preregistration Cars and Trucks: $15 (Day-of registration: Add $5, subject to space availability.)

Preregistration Motorcycles: $10 (Day-of registration: Add $5, subject to space availability.)

Price on Date of The Event - $5.00 per person, Kids enter free (12 and down)

Required Waiver of Liability, Release, and Payment Information

On behalf of the entire group participating in the 2017 Concord Mall Car Show, I assume all risk of bodily injury, property damage, and
personal damage that may occur by participating in the Concord Mall Car Show and, for myself/ourselves, their heirs, executors, and
administrators, do hereby forever waive and release any and all claims against and agree to hold harmless The Familia Car Club, and the
Concord Mall Car Show. Its committee, sponsors and volunteers, and the County of Elkhart with their respective officers, employees, agents,
representatives, volunteers, successors or assigns any kind from any and all claims which may be made for any cause whatsoever arising as
a result of participation. Further, I hereby consent to allow my picture or likeness to appear in any official document, news release, sponsor
advertisement and/or television and radio coverage of the events within or as part of the Concord Car Show, and grant permission to use
and/or publish photographic portraits, or pictures, video tape or film of me in which I may be included in whole, part, composite or
reproductions thereof in black and white and/or color or otherwise made through any media now known, for art, advertising trade or any
other similar lawful purposes whatsoever, including the publicity and promotion of this event itself, excluding commercial use of or by
marketing sponsors.

Print Name
(If on a club car, please allow the leader of your car club to sign as he will be responsible for the whole
group)
Signature
 For car club registrations questions, please call or text at
(574)349-3523 or (574)226-4921.

General Questions? Contact us at (574)349-3523 or Jorge_millan14@icloud.com

Categories/classes

1. Best Muscle
2. Bes Air Ride Setup
3. Best Static
4. Best Domestic
5. Best Wheels
6. Best Euro
7. Best Mini Truck
8. Best Lifted Truck
9. Best Diesel
10. Best Japanese Motorcycle
11. Best American Motorcycle
12. Best Interior
13. Best Custom
14. Best Engine Bay
15. Best In Show
16. Best Classic
17. Best Hot Rod
18. Best Car Club Representation
19. Limbo Contest Bagged
20. Limbo Contest Static
21. Peoples Choice
22. Furthers Traveled
23. Best Hatchback
24. Best Womens Car
25. Best V4 Cylinders
26. Best V6 Cylinders
27. Best V8 Cylinders
28. Vest V12 Cylinders (if any)
29. Rev contest 1st Place
30. Rev Contest 2nd place

CATEGORY SIGN UP SHEET

Category Name Vehicle Year Vehicle Make Vehicle Model VIN #

Note: Contact me if you have fill the signup sheet for a class/category for a trophy award to get you
process kicker and save you time on the date of the event.