Name:________________________________________
Club Affiliation:________________________________________
Address:_______________________________________________
City:_____________________ State:________ Zip:_________
Phone:____________________________________
Email:______________________________________________
Make :___________________________________________
Model:____________________________________________
Year:______________________________________________
Color:______________________________________________
Special Attributes:______________________________________
____________________________________________________
____________________________________________________
Signature:______________________________
Date:_________________________________
Make Checks Payable to :
East Jordan Lions Club
Send Form with payment to :
East Jordan Lions Club
PO Box 845
East Jordan, MI, 49727
The South arm classics that I will be entering is promoted by the East Jordan
Lions Club and will take place on July 9th 2022. This form indicates that I am the Owner
of the Car/Truck stated above. My signature signifies that I certify that I currently have updated
Insurance to cover any damage to other participants. I hold harmless volunteers and officers
of the south arm classics, the city of East Jordan as well as sponsors and or advertisers from
any actions, claims, assertion of liability that may arise with south arm classics.