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REGISTRATION FORM

Business Name: _____________________________________________________

Address: ___________________________________________________________

City: ____________________ State: _____________________ Zip: ___________

Contact Name: ____________________________ Phone: ___________________

Fax: ___________________________ E-mail: ____________________________

Size of Space: _______________ $ _____________

Electricity Needs: Yes_____ No______ Type of Plug: _______ # of amps _______

$40 for electricity

Each vendor must supply your own extension cords:

Suggested 100’ Minimum

TOTAL: $ __________________________________

· For costs…see Fees, Rules & Regulations

Vendor Description:

_____FOOD:

List Foods_______________________________________________________________ ________________________________________________________________________

All items must be listed above to be allowed sales at the event. GLD reserves the right to delete any item from your menu.

You will be notified if an item is deleted from your menu. Pricing must be consistent with competition.

_____MERCHANDISE:

List items________________________________________________________________

________________________________________________________________________

Required Information:

Registration Form ___________ Enclosed

Signed Statement of Waiver ___ Enclosed

Payment___________________ Enclosed

Harley Shootout Rally________

Time Machine Nationals______

Other Event________

Amount Enclosed: ___________

Return the above information by Aug 15, 2008 to: Great Lakes Dragaway/Harley

Shootout Rally P.O Box 51 Salem, Wi 53168

Attn. MaryLou Funk

Printable form click (PDF) or (Word)