2019 SUPER CRUISE ENTRY FORM 2019 SUPER CRUISE EVENT REGISTRATION/PAYMENT FORM March 16, 2019 Rain or Shine Vehicle, Motorcycle, Vintage Trailer or Boat Show Entry ($40 online pre-registration until March 1, 2019)UNIQUE ENTRY ID NUMBERUnique Entry IDA Unique Entry ID will be generated automatically when submitting this entry form. Use the Unique Entry ID for all car show purposes.ENTRANTFirst Name*Last Name*Club*No ClubClubClub NameAddress* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email-will be used to send your verification back to you* Phone*VEHICLEVehicle Information*> Click on (+) symbol on the right side to add more vehicles.Make VehicleModelYearColor Auto Insurance (List Provider)SPONSORINGAre you interested in sponsoring or being a sponsor/supporter? I am interested in sponsoring a merchant pick award $50/each. I am interested in being a Sponsor/Supporter of the event, contact me. How do you want your name or business to be printed on plaque(s) as award sponsor, fill in below?*> Tell us how your name is going to be spelled on the plaque(s).Do you want to pick your merchant plaque recipient or do you want us to do it for you?*I will attend event and pick recipientPlease have BCCC pick recipient for mePAYMENTCar Show Entry*> $40 per vehicle (DOE $45). Enter vehicle quantity. Price: $40.00 Quantity: Merchant Pick Awards Price: $50.00 Quantity: Total $0.00 Select Payment Method*Select belowPayPalCredit CardWhen you click the Submit button you will be directed to PayPal to complete your purchase!Credit Card*> This is a secure SSL encrypted payment. American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name CAPTCHALiability Release: In consideration of the acceptance to participate. Entrants, participants, spectators and/or riders release and discharge BCCC, Inc. its officers, agents, representatives, directors, volunteers, servants, sponsors, visiting clubs, sponsors, vendors, Fred Hall/Cal Shows, Kern Co. Fairgrounds and all owners and management of Kern Co. Fairgrounds and any and all clubs and organizations affiliated with BCCC or Kern Co. Fairgrounds from any and all known or unknown causes whatsoever that may be suffered by anyone participating in this event to his/her person or property. Event Management reserves the right to restrict entrants and/or their guests to behavior deemed acceptable during all activities of this event, including eviction should it become the opinion of event management that it is in the interest of safety, and/or proper behavior. The undersigned entrants acknowledge by his/her signature as having read and understood the above release of liability and waives all claims as outlined within. Any and all unsigned forms will be returned w/entry and release. Liability release to include all passengers. Entrant shall be 18 years of age; if under 18, parent or guardian must sign below. This entry form contains a Release and Indemnification Agreement. I have read and agree to all the conditions of the BCCC Inc. and Rules governing the event as set forth on this form and agree to observe all rules and decisions of the Event Management and Kern County Fairgrounds.