TEXAS T-PARTY REGISTRATION FORM

TYLER, TEXAS - OCTOBER 8-10, 2009

Return by September 1, 2009 with check made payable to Texas T-Party

(Mail to Jennifer & Ross Lilleker, 8437 Turkey Creek Rd, College Station, Texas 77845)

 

 

Driver's Name:                                                                                                  Sex:______________________

Address:                                                                             City:   _______________________________ State:  ___________________  Zip:_________________________

Cell Phone:  ________________________________________________                 E-mail Address:___________________________________________________________

Car Year:  ____________________________         Style/Model:______________________________________________

Insurance Company:                                                                       Policy Number:______________________________________________________________

 

List below Passengers 15 years or older                                                                List below Passengers  under 15 years                  Age       

 

                                                                                                                                                                                                                                               

 

Do you need a ride on the tour?  Yes/No  If yes, which days? _____________________________________________________

Would you permit others to ride with you on the tour? Yes/No  If yes, how many? _________________________________

Does anyone in your party require handicap access?   Yes/No

Does anyone in your party have any special dietary needs?  Yes/No Explain:________________________________________

#   Each     Amt Car and Driver (Includes 1 photo and 1 book) 1 @ $125.0 $125.00 Passengers 15 and over ___ @ $100  _______ Passengers under 15 ___   $0.00   Extra Photo ___ @ $10.00  _______ Extra Tour Book ___ @ $10.00 ________ Commemorative Name Tag dangles for" Tyler 2009" ___  @  $1.00  ________   Guest Tickets These tickets are available for short term passengers who would like to join us for a meal or event.  Meals for Under Age 15 are free, but we still need to know how many to plan for. Thursday Lunch Friday Lunch Friday Ice Cream Social Saturday Lunch Saturday Banquet       Due by September 1, 2009 Make checks payable to: Texas T Party             @ @ @ @ @     $10.00 $10.00 $5.00 $10.00   $20.00   Total Amount

Name of your local club:  ___________________ Is this the first T Party you will have attended? Y/N How will you be getting your T to Tyler? Driving or Trailering    How many miles: ______   Will you be joining us for the extra tours?  There is no fee for the extra tours.  Meals and entry fees are on your own. Wednesday, Oct 7th 2-5pm – Pre-Party Tour Yes/No Sunday, Oct 11th 9am-noon - Encore Tour      Yes/No   THE SPACE CITY T's of HOUSTON is a chapter of the Model T Ford Club of America and is a club interested in the preservation of Model T's.  Many hours have gone into hosting this event.  Registrants, by signing this registration form, agree to indemnify and hold THE SPACE CITY T's of HOUSTON and each of its members harmless from all claims, demands and causes of action arising out of negligence of the Registrant, his agents or employees and/or the ordinary negligence of the THE SPACE CITY T's of HOUSTON or any of its members.  Registrant also certifies that his/her car is in road-worthy condition. _______________________________________ Registrant Signature                                        Date Refunds for cancellations will be sent to registered drivers on funds available basis after final accounting.