WALTER P. CHRYSLER CLUB

                        10,000 LAKES REGION

                       18TH ANNUAL CAR SHOW

                Sunday, August 14, 2016 10:00 am to 3:00 pm RAIN or SHINE

                 All Chrysler(MOPAR), AMC/Jeep, and other Chrysler-related vehicles WELCOME

                       ***Entries MUST have Chrysler or other MOPAR-related power plants***

                                                      $10.00 registration fee per car

                           Proceeds go to - Iacocca Family Foundation for Diabetes Research  

                                                             www.iacoccafoundation.org

                                                               Co-sponsored & Hosted by:  

                      Wagner’s Family Drive-In

                 7000 West Broadway Ave. Brooklyn Park, MN. (763) 533-8262

    Awards for: Best Chrysler, De Soto, Dodge, Plymouth, Imperial, AMC/related

   Dash plaques, door prizes, Sponsor’s Choice award. Voting done by entrants.

   ******************** CLIP HERE FOR PRE-REGISTRATION *****************

  Include $10.00 check + this form and mail to:  WPC Club 10,000 Lakes Region

                                                                             c/o Bob Smith, Treasurer

                                                                             5045 16th Ave. S.

                                                                             Minneapolis, MN 55417  

For more information, contact Garry or Mickey at 651-646-5753.

NAME__________________________________ TELEPHONE #____________________________

ADDRESS_____________________________CITY__________________STATE_____ZIP_______

MAKE_________________________ MODEL____________________________ YEAR__________

More cars to enter? Write on back of page.

In consideration for the right to participate, all entrants discharge (by signing this form) the 10,000 Lakes Region of the Walter

P. Chrysler Club LLC, Wagner’s Family Drive-In, all other sponsors, employees, workers, volunteers and other agents and/or

anyone else connected with this event, from any known or unknown damages, injuries, losses, judgments and/or claims from

any cause whatsoever that may be incurred by any entrant to his or her property. Each entrant also expressly agrees to

i ndemnify all of the foregoing entities, persons or bodies of and from all liability occasioned or resulting from the conduct of

entrants, spectators or other participants. Event management reserves the right to restrict participants and spectators to

acceptable behavior during the event. If, for any reason, an entrant’s actions or vehicles are deemed unacceptable by

management, the parties and/or vehicles involved will be asked to leave the premises. Objectionable behavior off the premises may be grounds for denial of entrance to the event.

Signed ___________________________Date_____________