Independence Day Car Show Registration

Independence Day Car Show Registration Form

Hold Harmless Agreement:

By submitting this form the undersigned accepts and assumes all risks, claims, actions and damages direct or indirect, which is sanctioned by the Conconully Chamber of Commerce. I expressly agree that I will hold the Conconully Chamber, the event directors, the Town of Conconully and all of their respective officers, employees, agent representatives, successors and assignees harmless, and otherwise indemnify the same, from and against such risk, claim action, or damage arising from my participation in any event. It is my expressed intention that this disclaimer and hold harmless agreement is binding upon my agents, representatives, heirs and assignees. ~ All photos taken during show are property of Conconully Chamber & may be used for advertising

Payments:

Submit form to pay online, or obtain an application ID to include with a mailed check for $25 by July 1st to:

Conconully Chamber of Commerce
PO Box 309,
Conconully, WA 98819

If you have any questions please contact:

Starr 509- 322-4110 or
Janet 509-826-2241 or 206-954-2747

Name *
Address *
Phone *
Email *
T Shirt Size *
Extra T Shirt $15
EMail me a copy of this submission  
  After you submit this form you will be taken to a page that will give you an application ID (for mailing a check) and also provide you with an opportunity to pay online if you choose.
* = required