Saturday 13th February 2010

 PLEASE PRINT CLEARLY

 Pre-entry for the entire event,
 i.e. the Show and Shine, the Poker Run and the Destination BBQ,
 costs $50.60 (inc GST) per vehicle. Cheque or money order
 payable to

Big Al's Poker Run
PO Box 377
TUART HILL WA 6939

Post to:
Big Al's Poker Run
PO Box 377,
TUART HILL WA 6939

RESTRICTED ENTRY
Read  the home page for Vehicle  Qualifications.

Please Note: Entry to Charles Paterson Park is restricted to entrants participating on the Poker Run. Vehicles intended for display only in the Show and Shine can no longer be admitted to the park.

 All vehicles not pre-entered by the last mail Wednesday 3rd Feb and attending on Saturday February 13th  will be charged an entry fee of $60.00 (inc GST).

Our Public Liability Insurance requires us to remind you that alcohol is not permitted at both venues.

Refunds will not be offered except in exceptional circumstances.

Payments can be made by direct deposit to:
BSB: 736 053
(Westpac Mt Hawthorn)
ACC: 552 660
Please include Car Rego No with payment for identification.

All entries must be on this form and in the mail by last post Wednesday February 3rd 2010.
Contact phone number essential.

Big Al's Poker Run and Big Al's Picnic and Barbeque are organised by Lloyd's Panel Masters Pty Ltd.
I understand that by paying the entry fee, or by participating in the Run,

I agree that:
1. Lloyd's Panel Masters Pty Ltd, and it's employees and agents (collectively "Big Al") will not be liable to me for its negligence or breach of statutory duty causing or contributing to any loss, damage, injury or liability which I may incur during, connected with or arising out of the Run
which includes the associated car display and social events).

2. If Big Al accepts liability or is determined to be liable to anyone for its negligence or breach of statutory duty causing or contributing to any loss, damage or injury arising out of my participation in the Run, I shall indemnify Big Al against any such liability.


Signature:          _______________________________ Date: __________________

Additional Order:

Mens 'T' Shirts - Black (specify qty require'd @ $33inc GST each):

Womens Open Neck 'T' Shirts - Black (specify qty require'd @ $33inc GST each):

2010 Calendar (specify qty require'd @ $10inc GST each):

TOTALS:

     _____ x Pre-entry @ $50.60 = $_____________

     _____ x Shirts    @ $33.00 = $_____________

     _____ x Calendars @ $10.00 = $_____________

     Total Amount Payable       = $_____________

OFFICE USE ONLY:

Received:      ___________________

Name:        _____________________________________

Payment:   ________________________________________________