| Personal Information |
| For multiple cars, please photocopy this page. |
| Name |
| Address |
| City/State/ZIP |
| E-mail Address |
| Tel. (Days) | Tel. (Eves.) |
| Tel. (Cell) | Tel. (Fax) |
| GENERAL PUBLIC PASSES |
ShowPass (For General Public/Non-Corvette Drivers)
$17 Per Person - One-Day Admission & Non-Corvette Parking | |
| x ___ no. passes = $ | ____Total |
| $50 Per Person - Four-Day Admission & Non-Corvette Parking | | |
| x ___ no. passes = $ | ____Total |
| CORVETTE ENTERTAINMENT |
GoldField (For Corvette Drivers)
$15 Per Person, One-Day Admission & Corvette |
| x ___ no. passes = $ | ____Total |
| $40 Per Person, Four-Day Express Pass & Corvette | | |
| x___ no. passes = $ | ____Total |
GoldYear (50th Anniversary 1954 Corvette)
Free GoldField to all driveable 1954 Corvettes |
| x____ no. of cars = $ | 0 Total |
| Includes GoldField and GoldTour passes |
GoldInvitation Callaway Corvettes
(Includes GoldField and GoldTour passes)
$15 Per Person - One Day Admission & Corvette |
| x ___ no. passes = $ | ____Total |
| $40 Per Person - Four Day Express Pass & Corvette | | |
| x___ no. passes = $ | ____ Total |
GoldTour (Stages OFFSITE @ 5:00 p.m. Saturday)
Free to All GoldField/GoldMine registrants with window stickers |
| = Free | Total |
For Office Use OnlyMR#Date
Corvette Parts & SalesGoldRush (Corvette Auction)Send me Seller's Registration Package including pricing, options, times and procedures so I may register.
Send me Bidder's Registration Package including pricing, options, times and procedures so I may register.
GoldMine (Corvettes for Sale by Owner)
$200 Includes Four-Day Admission for two people and Corvette |
| x ___ Corvettes = $ | _____ Total |
GoldMarket (Swap Meet & Exhibitor Space)
10' x 24' Outside Exhibitor Space @ $ 85 |
| x _____no. spaces = $ | _____ Total |
| 10' x 24' Outside Corner Exhibitor Space @ $125 |
| SORRY, SPACE SOLD OUT | |
| 10’ x 20’ Outside Premium Exhibitor Space @ $600 | | |
| x __1__no. spaces = $ | _____ Total |
| 10' x 20' Outside Premium Exhibitor Space Each addl. @ $350 |
| x______no. spaces = $ | _____ Total |
| 10' x 10' Outside Golf Course Exhibitor Space @ $200 |
| x______no. spaces = $ | ______Total |
| 10' x 10' Inside Exhibitor Space @ $200 |
| SORRY, SPACE SOLD OUT | |
| 10' x 10' Inside Premium Exhibitor Space @ $600 |
| x___1__ no. spaces = $ | ______Total |
| 10' x 10' Inside Premium Exhibitor Space Each addl. @ $350 |
| x __ __no. spaces = $ | _____ Total |
| Please inquire about availabilities for other spaces, sizes, and prices. |
| Judging Events |
| Gold Certification $300 Four-Day Admission for 2 people |
| Year ______ _____ no. of Corvettes = $ | _____ Total |
| Survivor $200 Four-Day Admission for 2 people |
| x ______ no. of Corvettes = $ | _____ Total |
| Benchmark (Must register also for GoldCertification & Survivor) |
| $150 Per Corvette |
| x ______ no. of Corvettes = $ | _____ Total |
| Educational Workshops |
GoldSchool Circle Workshops you wish to attend.
Registrations of $200 and over include 4-Day Admission for 2 people. |
| $50 Lecture Class1 2 3 4 5 6 7 8 9 10 12 13 14 15 16 17 18 |
| x ___ no. of $50 classes = $ | _____ Total |
| $100 Hands-On Class 1 3 4 5 6 7 8 9 11 12 13 14 15 17 19 20 21 22 | | |
| x ___ no. of $100 classes = $ | _____ Total |
| Rig Parking |
| GoldiLock (Limited-Access Secured Trailer Parking) |
| $125 per single car trailer x ______ no. of Trailers = $_____ Total |
| $250 per multi-car trailer x _____ no. of Car Haulers = $_____ Total |
| $350 per semi-trailer x _____ no. of Car Haulers = $_____ Total |
| Trailer Parking (Unlimited Access) |
| Free Trailer x _____ no. of Trailers = $ | Free Total |
| Motor Home Registration $200 Four-Day Admission for 2 people and Overnight Parking |
| x ______ no. of Coaches = $ | _____ Total |
License PlatesOfficial Commemorative Plates$100 per pair for year numbers '68 through '82$200 per pair for year numbers '53 through '67 & 283, 300, 327, 340, 350, 360,365, 375, 390, 396, 400, 425, 427, 430, 435, 450, 454, or 500$ 45 per pair all others Contact Cathy Storm, See Below
GoldTour Plates$ 15 per plate Contact Cathy Storm (815) 568-8888OR E-MAIL bginfo@bloomingtongold.com
2004 Registration Grand Total $____________________________________
Advance Registration closes June 7, 2004
No Refunds —a letter will confirm your registration |
| Method of Payment | Visa | MasterCard |
| Check or Money Order Enclosed (payable to Bloomington Gold) | |
| Card Number: _________________________________________________ |
| Expiration Date: _____/ _____ |
| Signature _____________________________________________________ |
ReleaseI agree to insure my vehicle and property against loss, damage and liability. I acknowledge that I am neither an agent of, nor in joint venture with, Bloomington Gold(r) or McArdle Ltd/Pheasant Run Resort, and hereby agree to hold it and its representatives harmless from and against all claims for damages or injuries of any nature whatsoever including, but not limited to, claims arising in connection with the theft, damage, or destruction of my property or any injury to me and/or others during, or as a consequence of, this event. In addition, I agree to hold harmless Bloomington Gold(r) or McArdle Ltd/Pheasant Run Resort and its representatives for any and all claims arising from any action by me during this event. I agree to assume all risks and obligations as a buyer or seller of automobiles for the transfer of all monies, papers and titles.
Signature Note: Unsigned forms will be returned and registration voided.
Upon completion of this Registration form, mail to: Bloomington Gold, 950 Greenlee St., Marengo, IL 60152, or fax to: 815/568-6615.