Rollin In Weed Car & Bike Show Application Form Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Registration (Early Bird)(Required)Register through August 19th for Early Bird Pricing. After August 19th, prices increase to $45 for Vehicle with T-Shirt and $35 for Vehicle Only. $40 Vehicle (includes one T‐shirt) $30 Vehicle Only I am registering a Car Truck Motorcycle Make/Model Year(Required) Additional T-ShirtAdult Shirt Sizes Cotton/Poly Blend.NoneSmallMediumLargeXL2XL3XLTerms and Conditions(Required)The Weed Chamber of Commerce and its officers and members are released and discharged from any and all claims from and all known and unknown damages or injuries from any cause what‐so‐ever that may be suffered by any entrant, participant, or spectator, to his or her person or property during the event. I have read and agree to all conditions and rules governing this event and WILL NOT hold the Weed Chamber of Commerce and its officers and members responsible for any losses or damages during the event.Total $0.00 EmailThis field is for validation purposes and should be left unchanged.