GARDEN STATE FALLOUT 15 REGISTRATION FORM


Name....................................................................

Address.................................................................

City/State/Zip..........................................................

Phone...................................................................

Truck Make...................Year........                       for council
                                                                use only

# of Persons over 12 years..............         form#...................

Club Affiliation........................         veh.....................

Check for Club trailer or camper........         tra.....................

Pre-Reg Deadline Friday, August 25th, 2000       extra...................
                                           
Make all checks payable to NJVC                  total...................

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I, the person named and signed, accept full responsibility for any theft,
fire, and/or damage to my vehicle and/or contents; for the conduct of myself
and/or passengers and/or animals I brought to this event. I also release the
NJVC, and their affiliated Clubs, and the Warren County Fairgrounds, for any
and all responsibility for damage or injury to myself and/or my party as a
result of participating in this Event.

The NJVC and the Warren County Fairgrounds reserves the right to refuse any
entry. If you are under 21, a parent or legal guardian must also sign this
form.

Date..........Sign Here.................................................
Send check to NJVC c/o 186 Gatzmer Avenue, Jamesburg, NJ 08831

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            NO BOTTLES PLEASE!!!           USE CANS AND RECYCLE!!!

                     Please use no styrofoam products


                         FOR MORE INFORMATION CALL:

                   Sharon..............(732) 521-0917
                   Judi................(732) 745-7790