Josh Heilbron Benefit Car & Motorcycle Show Saturday, October 21, 2006 Ryan Park, Lompoc CA Time : 9am to 3pm (registration 7:30am - 9:30am) This is a benefit Car Show for Hot Rod/Cycle enthusiast businessman and local Lompoc resident Josh Heilbron who is currently in the hospital fighting Cancer Profits will go to help pay for medical treatments, medications, and his other expenses! Pre-Registration $20 until October 18th $25 Registration on day of Show (pre-registration includes 1 BBQ lunch ticket per entry) We will have a SILENT AUCTION, GAMES, RAFFLE, SHIRT/HAT SALE, and Great Barbeque REGISTRATION APPLICATION Name______________________________________Phone_____________________Cell________________ Address___________________________________City__________________State________Zip________ Make of Vehicle ___________________Model_________________Year_______Class_______________ Please Select your ENTRY CLASS : 15a-VW's (air cooled) 1 - Daily Driver (up to 1985) 8 - Restored (1959-74) 15- Import Cars (to pres) 2 - Antique Cars (pre-32) 9 - Custom/HandCrafted Cars 16- Import Modified Cars 3 - Street Rods (open pre-32) 10- Competition/Pro Street 17- Exotic Cars (to pres) 4 - Street Rods (closed pre-32) 11- T-Bird (all) 18- Trucks (up to 1960) 5 - Street Rods (open 32-49) 12- Corvette (all) 19- Trucks (1961-present) 6 - Street Rods (closed 32-49) 13- Mustang/Camero (all) 20- Custom Motorcycles 7 - Restored (1932-58) 14- Muscle Cars (1964-71) 21- Antique Motorcycles SPECIAL AWARDS - Best Paint + Best of Show + Josh' Choice --------------------------------------------------------------------------------------- REGISTRATION Payment and DONATIONS can be credit card, check, or money order ----------------------------------------------------------------------------------------- Mail or FAX the completed form with your payment to: Josh Heilbron Benefit Trust c/o Russ Rodrigue 116 E. College Ave. Suite 170 Lompoc, CA 93436-5335 FAX to 805-737-9846 (we can accept checks by FAX too!) Visa/M/C/Disc/Amex ________________________________________Exp. Date__________________ (If using a credit card, a charge will be on your statement by Rodrigue and Sons Co.) I understand by signing below I am absolving the Josh Heilbron Benefit Trust and City of Lompoc and anyone else connected with the management of this event from any and all known damages, injuries, losses, judgements, and/or claims from any cause whatsoever that may be suffered by any member to this person or property. Further, entrant agrees to indemnify all the forgoing entries, firms, persons and/or bodies from any and all liability occasioned or resulting from the conduct of entrants or participants assisting or cooperating with entrant and under the direction and control of entrant. Signature__________________________________________________Date_______________________ YES, I hereby agree to the above terms and/or authorize this charge e-mail josh.benefit@yahoo.com or call Russ 805-735-7103 or Gil 805-757-1765