Registration  Form   Entry  Fee:    $30.00   Late  Registration  on  Feb.  4th,  2017:    $40.00  

Make  checks  payable  to:    Bullhead  City  Lion’s  Club     Last  Name:_____________________________First  Name:___________________________________     Address:  ________________________________City:  _____________________State_____  Zip  ___________     Phone:  __________________________  E-­‐mail  Address:  _________________________________________     Car  Club:  _____________________________    License  #_______________________     Year:  ___________Make  _____________Body  Style  ______________Color____________       The Lions were challenged in 1925 by Helen Keller to be “knights of the blind”. Helen’s personal experiences led her to educate the public about aspirations, hopes and abilities of people who are blind or visually impaired. In turn, the Bullhead City Lion’s Club has dedicated themselves to assisting the local community with their vision needs. Last year the club was able to help 30 children with exams and glasses and we hope to exceed that number to include adults in the near future. One hundred percent of your donations will be used for eye exams and glasses for children and adults in the area. Thank you very much for your support of this worthy cause.

  DISCLAIMER:    In  consideration  of  the  acceptance  of  the  right  to  participate,  entrants,   participants  and  spectators  by  execution  of  this  entry  form,  release  and  discharge   the  Bullhead  City  Lion’s  Club,  Robert’s  Resorts  (Vista  Del  Sol  Resort)  and  their   officers,  directors,  employees,  agents,  representatives  and  anyone  else  connected   with  the  management  or  presentation  of  the  “Roarin’  on  the  River”  Car  Show  from   any  and  all  known  or  unknown  damage,  injuries  or  losses,  judgments,  and/or  claims   from  any  cause  whatsoever  that  may  be  suffered  by  any  entrant,  his  heirs,  executors   or  assigns  to  his  person  or  property.    Further,  each  entrant  expressly  agrees  to   indemnify  all  of  the  foregoing  entities,  firms,  persons,  and  bodies  of  and  from  any   and  all  liability  occasioned  by  or  resulting  from  the  conduct  of  any  entrant(s),   participants(s)  assisting  or  cooperating  with  entrant.     Signature    _______________________________________________    Date  _______________________     Send  entry  to:    Roarin’  on  the  River  Car  Show          Attn:    Lion  Janis  Young          6331  S.  Calle  Marsilla          Ft.  Mohave,  AZ  86426   If  you  need  a  receipt,  please  make  a  copy  of  this  registration  form  and  send  the  copy  to  us.  The  Bullhead   City  Lions  Club  is  now  a  501(c)3  non-­‐profit  organization.