22th Annual Antique Truck Show & BBQ Saturday April 25 2009 At Kirkland Ranch Gates open @ 6am Friday & Saturday for Truck Unloading & Parking Send This Form and Check Payable to Central California Chapter ATHS To Margaret Garcia 8412 Buckley Road Dixon Ca 95620 My signature below acknowledges and certifies that my vehicle owned or operated by me in any ATHS sanction event is covered by Primary Individual Liability Insurance, is in safe working order, and complies with all applicable regulations. The vehicle operator is competent to drive the vehicle, and holds a valid driver's licence. I understand and agree to abide by all ATHS Antique Truck Show safety rules. Each Registration Fee Includes One Dash Plaque and covers all trucks brought to the show. There is no extra fee For Additional trucks. Need a RV Space? Yes______No______ Description Of Vehicle Year               Make               Model               Body Style               Overall Length ________      _________       _________      _____________          _____________ ________      _________       _________      _____________          _____________ ________      _________       _________      _____________          _____________ Truck Registration                        $10.00               $__________ Saturday BBQ Dinner  _____ @ $17.00 Each = $__________ Children Under 12 ________ @ $ 7.00 Each =   $__________ Sunday Brunch  __________ @ $  6.00 Each=   $__________ Additional Dash Plaques _____@ $5.00 Each =$__________                                      ____                              Total $__________ Signature_________________ Date___________________ Name____________________________________________ Address__________________________________________ City_______________________State______Zip__________

Kirkland Ranch Show Registration Form