R E G I S T R A T I O N

Name_____________________________________

Address___________________________________
             ___________________________________

City___________________  State___  Zip________

Telephone (___) ____-__________

Club Affiliation_________________

Vehicle Year______  Make____________
Model_____________________________

Advanced Fee.....$8.00
Day of Show......$10.00		 Total $___________


Fill out this form and send with a check to:
Port Fish Day
c/o Scott Ferris
2119 Delaware Ave. Apt. D
Grafton, WI 53024
LIABILITY: In acceptance of this application for Fish Day Annual Car/Truck Show, I expressly release all members, officers, agents, and sponsors from any causes, whatsoever, that may be suffered by my family, or guests while attending this said event, I understand each participant will be solely responsible for their own vehicle and personal property.

________________________       __________
      Signature of Applicant                      Date

� 2004 PortFishDay.com