19th Annual

   Arizona Classic Bronco Stampede

MARCH 19th-21st, 2010

 

Print out these pages for reference and either register online using the form at the bottom of the page, Or fill out the printed forms and return them to ACB with payment.

 

 

PRE-REGISTRATION DEADLINE:  March 1, 2010

 

Name  ___________________________________________ Phone (            )__________________

 

Address ___________________________________ City/St/Zip _____________________________

 

email: _________________________________________________________________________

 

Vehicle: Yr: _______  Make: _____________ Color: _______________ Lic. Plate # ________________

 

Insurance Carrier: __________________________________Policy #___________________________

 

ARIZONA CLASSIC BRONCO STAMPEDE Registration Fees:

ACB Members Bronco Registration                             #______@$ 45.00          _________             

Non-Members Bronco Registration                              #______@$ 55.00          _________

(Both registration types include Dash Plaque & 2 Meals)       

Extra Dash Plaque                                                     #______ @$ 5.00          __________

Extra Dinners:                                                           #______ @$13.00          __________

T-Shirts:                                                                    #______ @$15.00          __________

Adult T-SHIRT Sizes:     Sm _____ Med. _____ Lg. _____

XL _____ XXL _____ XXXL _____

                                                                      TOTAL ENCLOSED:       $___________

 

ADDRESS CHECKS TO:  “ARIZONA CLASSIC BRONCO”

MAIL Form, Checks & Disclosure to:       ARIZONA CLASSIC BRONCO

                                                            PO BOX 67321

                                                            Phoenix, AZ  85082-7321

 

 

 

HOLD HARMLESS:  I HEREBY DECLARE that I am over 18 years of age and agree to conform and comply with the ideals governing this event.  I further DECLARE I am aware of the Drinking and Driving Laws.  I acknowledge Arizona Classic Bronco, Inc. does not condone, nor will permit drinking alcoholic beverages while on a trail.  I understand there is a possibility of an accident and that the Arizona Classic Bronco, Inc. will do all in its power to assure a safe and successful event.

 

THEREFORE; I hereby assume all risks involved in connection with this event.  On behalf of myself, my family, heirs and assigns, I release the Arizona Classic Bronco, Inc., its officers and/or members from any and all liability due to harm, injury or damage which may befall me, my vehicle, my family or guests, whether foreseen or unforeseen.

 

I am of lawful age and legally competent to sign this agreement.

 

Drivers Signature: ______________________________________Date: __________________

 

 

 

ADDRESS CHECKS TO:  “ARIZONA CLASSIC BRONCO”

MAIL Form, Checks & Disclosure to:       ARIZONA CLASSIC BRONCO

                                                            PO BOX 67321

                                                                                                            Phoenix, AZ  85082-7321

 

The rest of this page is for ONLINE REGISTRATION ONLY. Fill out the form above FOR MAIL-INS or

COMPLETE SECTION BELOW AND USE 'CONTINUE TO CHECKOUT' BUTTON AT BOTTOM!

 

Please provide the following contact information (All Fields Required):

Name
Phone
E-Mail
Address
City
State
Zip
Vehicle Year
Vehicle Make
Vehicle Color
License Plate #
Insurance Carrier
Policy #

HOLD HARMLESS:  I HEREBY DECLARE that I am over 18 years of age and agree to conform and comply with the ideals governing this event.  I further DECLARE I am aware of the drinking and driving laws.  I acknowledge Arizona Classic bronco, Inc. does not condone, nor will it permit drinking alcoholic beverages while on a trail.  I understand there is a possibility of an accident and that the Arizona Classic bronco, Inc. will do all in its power to assure a safe and successful event.

THEREFORE; I hereby assume all risks involved in connection with this event.  On behalf of myself , my family, heirs and assigns, I release the Arizona Classic Bronco, Inc., it's officers and/or members from any and all liability due to harm, injury or damage which may befall me, my vehicle, my family or guests, whether foreseen or unforeseen.

I am of lawful age and legally competent to sign this agreement.

Do you agree to the above statement? Yes
Drivers Signature
Date
After Clicking on "Continue to Checkout" you will be taken to the Online store to purchase your Registrations, T-Shirts and Meal Tickets.