Read 2011 Jeep Jaunt NEW LAYOUT text version

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To benefit

in partnership with

Registration is at Celebrity Theatres, Highway 90, Broussard. Registration Opens at 7:00 a.m. and Closes at 9:00 a.m. Ride departs Celebrity Theatres at 9:30 a.m. Vehicles arrive at Cypress Bayou Casino/Shorty's at 11:00 a.m.

Approximately 35-mile police-escorted ride from Celebrity Theatres in Broussard to Cypress Bayou Casino/Shorty's in Charenton, LA This All-Age Indoor Event in Cypress Bayou Casino/Shorty's Pavilion will be from 11:00 a.m. till 2:00 p.m. (No Pets, Please)

Must be postmarked by October 14 (First 300 receive official ride t-shirt, size guaranteed if received by September 26)

Sunday, October 23, 2011

PRE-REGISTRATION $20 Per Person

REGISTRATION

Day of Ride

$25 Per Person

Registration includes lunch (compliments of Cypress Bayou Casino/Shorty's), Door Prizes, Live Auction and more! All Jeeps and 4x4's are welcome, riders 7 years and older must be registered.

*FOR `jeep jaunt' INFORMATION Contact John Falcon 337-849-8928 · [email protected] · www.ajrf.org

In consideration of the acceptance to participate in this benefit ride, by execution of this entry form, I hereby acknowledge that I have a valid driver's license, insurance, and that my vehicle is street legal, and that I must be 21 to enter casino.

Driver's Name ________________________________________ Shirt Size _______Driver's Signature _____________________________________

PRINT

Address ______________________________________________________City __________________________ State __________ Zip ____________ Phone Number _______________________________ Type of Vehicle_______________________ Email Address _________________________ Passenger Name _____________________________________ Shirt Size _______Passenger Signature __________________________________ Passenger Name _____________________________________ Shirt Size _______Passenger Signature __________________________________ Passenger Name _____________________________________ Shirt Size _______Passenger Signature __________________________________

Make checks payable to: American Lung Association of Louisiana Mail Pre-Registration to: AJRF, P Box 1036, Youngsville, LA 70592-1036 .O.

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2011 Jeep Jaunt NEW LAYOUT

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2011 Jeep Jaunt NEW LAYOUT