UPDATED INFORMATION FEB 7

Pre Registration until May 2- $20.00   Day of Show $25.00.

For More Information: 

website: www.copsandroddersPA.com

Contact Joel 215-208-3366

Send Completed form Along With Your Check Payable to:

“Bensalem Township Police Activities League”, 2400 Byberry Road Bensalem, PA 19020

Name,                                                         Email,                                      Telephone,

Address:  City,                        State,                            Zip,

Make of Car,                           Model,          Year,       Color.

I understand Bensalem Township, Park Casino, Liberty Region Corvette Club, the Show Sponsors and/or any other organization or person working or associated with this event is not responsible for the loss injury to me, my passengers, my property or my passenger’s property and time due this event.  I understand that all vehicles entered in this show must be covered under a current auto insurance policy.  I also understand that bringing alcoholic beverages, cooking appliances and/or firearms to this event is strictly prohibited.  I am aware that myself, my passengers and/or my vehicle may be photographed and subsequently used inn LRCC, Bensalem Township or Part Casino publications, including electronic media, promotional literature, advertising and other similar communications.  By signing this waiver I agree to these terms.

Print Name___________________________________
Signature____________________________________