Driving the Dixie

HTML Scrolling Text Boxgreat free widgetsWidgetbox

Name *

Address *

City *

State *

Zip *

Phone

How did you hear about the event? *

Make and Model *

Year of the Vehicle *

Insurance *

Insurance carrier *

Policy # *

I certify that on June 20,2009 my drivers license, vehicle registration and automobile liability insurance are current and valid. I agree neither that A's R Us chapter, Model A Ford Club of America nor the Dixie Highway communities are responsible for loss or injury to property or myself. I shall assume any, and all liability for such loss, damage or injury. Further, any loss or damage caused by myself to others shall be my personal responsibility.

Online signature *

Re-typing or signing verifies understanding of waiver

Print by using File on the navigation bar,or Rt. click mouse and print.

Send check for pre-registration for $10:00 to: A's R U's at P.O.Box 3 Crete, IL. 60417

Need assistance with this form?

Remember you need to Right Click and print the form and send it in to us. Thank You.

Header picture:

1931 Ford AA truck. Typical signage of the period on the truck. This picture was taken at Crown Point during the filming of "Public Enemies" in 2008.