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Registration Form 2010


Name:

Guest:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Year:

Make:

Model:


Insurance & Policy Number: ______________________________________________________________


Registration Fee $49.00 ---- For information: [email protected]


DVD of 2010 POCI Conference
(note: DVD’s will be edited, produced and shipped after the POCI Convention)
DVD’s are $25.00 each: quantity ____________ x $25.00 = Total $

T-Shirts
T-Shirt are $20.00 each: S ____ M _____ LG ____ XL_____ 2XL _____ 3XL______

Make checks payable to “Almost Heaven Region”
Survey to help prepare advanced planning.
Will you need trailer space? Yes No
Will you need RV Space? Yes No
How many people in your group?
How many days do you plan to attend?

OPERATION: Event management reserves the right to deny admission to any persons at management’s discretion. Objectionable conduct
or appearance, as determined solely by events management, will result in eviction of the entrant and vehicle, such behavior may
include unnecessary tire spins, distribution of unapproved printed matter, gang or biker related apparel or any other activity or thing
which in the opinion of the management may be detrimental to the public image of the convention. In case of any eviction, the POCI
Convention shall not be liable for refunds of any fees or admissions paid.
LIABILITY: In consideration of acceptance of this entry and the right to participate, entrant(s), on entrant’s own behalf and on behalf of entrant’s
guests and participants does hereby unconditionally agree to fully release, discharge and hold harmless the POCI, the Almost Heaven Region
of POCI, the City of Charleston-West Virginia, the state of West Virginia, Kanawha County, their offi cers, directors, employers, agents representatives,
servants and anyone else connected with the management or presentation of the POCI convention of and from any and all known or
unknown damages, injuries, losses, judgments, and/or claims from any cause whatsoever that may be suffered by entrants to their person or
property and the person of entrant’s guests and participants. Further, each entrant expressly agrees to indemnify and hold harmless all of the
foregoing entities, fi rms, persons and bodies of and from any and all liability occasioned or resulting from the conduct of entrant, their participants
or guests, or cooperating with entrant or under the direction or control of entrant which may cause injury to the person or property of others while in
attendance or participating in the activities of the POCI. Entrants agree that participation in any contest, games or activities may be limited to vehicles
which have completed the POCI Convention Vehicle Safety Inspection, however, entrant acknowledges and agrees that entrant is in no way
relieved of liability nor does POCI Convention assume any liability of any kind or nature whatsoever upon performing a safety inspection. Entrant,
on entrant’s own behalf and on behalf of entrant’s participants or guests, acknowledges and agrees that in the event of any claim or controversy
arising between entrant and POCI Convention that this agreement has been entered into in Charleston, Kanawha County, West Virginia, and that
any and all claims or controversy shall be under the jurisdiction of the West Virginia Courts in Charleston, Kanawha County, West Virginia.
I acknowledge that I have read the above statement and herby agree



_______________________________________________________
Signature


Mail this form to: POCI Convention 2010 Attn:

Larry Bailey
21 Holly Circle
Winfield, WV 25213
 

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Member of the 500+ RWHP Club!
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