Southeast Willys Jeep Get Together Registration

New Event Location:

125 Underwood Rd, Fletcher, NC 28732

Mailing Address:

Southeast Willys Jeep Get Together, 65 Wilkie Way, Fletcher, NC 28732

YOUR CONTACT INFORMATION

First NameLast Name

Nickname

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Distance Traveled

Cell/Phone

Area CodePhone Number

E-mail

How did you find out about us?

WILLYS INFORMATION

Year

1941, 1942, 1943, etc....

Model

Military, CJ, FC, Jeepster, Truck, Wagon, GPW

Color

Red, Blue, Pink, Green, etc...

REGISTRATION (Please check boxes below to complete your registration)

General Admission [1 ticket for general public OR additional exhibitor guests]$5.00

Choose Quantity

Exhibitor [includes: 1 exhibiting Willys vehicle; 2 admission tickets; 1 goodie bag]$25.00

Additional Willys Vehicle [includes: 1 Willys vehicle; 1 admission ticket; 1 goodie bag]$10.00

Choose Quantity
Item subtotal:$0.00

Swap Meet Space [includes: 1 parking space; 1 admission ticket; 1 goodie bag]$10.00

Choose Quantity
Item subtotal:$0.00

T-Shirt(s) [Check box for size/qty. Pre-orders available before 9/1. No shipping.]$15.00

T-Shirt Size	Select Quantity Per Size
S
M
L
XL
XXL
XXXL

Item subtotal:$0.00

Lunch [Typical Southern Food, i.e. chicken or meatloaf, vegetables & sweet tea.]$10.00

Choose Quantity
Item subtotal:$0.00

Willys Whirl Countryside Ride with Group Meal Afterwards [cost of meal not included]$ Free

Total $0.00

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Click blue "Submit" button below to pay online via PayPal

OR

Click blue "Print Form" button to sign & mail US Post with check, payable to:

Mailing Address: Southeast Willys Jeep Get Together, 65 Wilkie Way, Fletcher, NC 28732

*Mandatory Liability Release: The undersigned, desiring to participate in the Southeast Willys Jeep Get Together, does hereby tender his/her application. In consideration of this application, the undersigned does hereby: 1) release the Southeast Willys Jeep Get Together, other vendors and all respective staff, volunteers, and agents from any and all liability arising from the event, 2) Release all other participating business entities and participants from any and all liability from the event, 3) give permission to use any photographs or information obtained prior to the event for print or publication, 4) agree to have vehicle liability insurance required by the state of North Carolina DMV. The Southeast Willys Jeep Get Together is not responsible for the use or operation of said vehicle and is not responsible for any damage to any of the entered vehicles. Forms must be received by the Southeast Willys Jeep Get Together prior the event.

Signature is required for mailed forms: ______________________________________Date____________

I understand and agree I am subject to all the above:*

I agree