"*" indicates required fields Participant Name* First Last Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Email* Year Make Model Reg # Engine Make CC/HP Condition Original Restored Feature Type Youth Teen Year Make Model Reg # Engine Make CC/HP Condition Original Restored Feature Type Youth Teen Year Make Model Reg # Engine Make CC/HP Condition Original Restored Feature Type Youth Teen Year Make Model Reg # Engine Make CC/HP Condition Original Restored Feature Type Youth Teen Liability Agreement: In consideration of the acceptance of the right to participate, participants and spectators, by signing this release, release and discharge NHSMA and all of their volunteers who help in the running of the 2022 NHSMA Annual Winter Rally of and from any and all known or unknown damages, injuries, losses, judgments and/or claim from any cause whatsoever by signing this liability agreement, expressly agrees to indemnify and hold harmless all of the foregoing entities, firms, persons and/or bodies of and from any and all liability occasioned or resulting from the conduct of any participant assisting or accompanying or cooperating with participants. Further, participants agree that he/she has the authority that all of the terms as set forth herein shall be binding as to his/her minor children and guests who may be accompanying participant during this event.Signature Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. Δ DOWNLOAD FORM