Is this a new Address?(Type "Yes" or "No")
Is this your first time to the event?(Type "Yes" or "No") If no, how many times?
Area Code & Phone Number
Corvette Color and Model Year
License Plate Number
What State is the License Plate Registered In?
By submitting this form I verify that the vehicle entered into the Eureka Springs Corvette Weekend at Eureka Springs, AR is insured against loss, damage and liability. I agree to assume any risks of any and all damages or injury and to indemnify and hold harmless the Eureka Springs Corvette Weekend, Inc. its officers, directors, and agents for any and all acts of omission which may result in the theft, damage, or destruction of my property, or injury to me or others occurring during, or as a consequence of my participation in this Event.
Please remember that your $50.00 membership is not refundable or transferable. YOUR INFORMATION IS NOT SAVED UNLESS YOU HAVE PAID. Thank you.
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