Name_______________________________Telephone________________

Address_____________________City______________State____Zip____

Make/Model___________________________________Year___________

Must Submit Photo $30.00 per Vehicle,
$25.00 per Motorcycle
(If more than 1 entry list on separate sheet)

Check Payable to California Concours d’ Automobile
P.O. Box: 15076 Long Beach, CA 90815

Yes, I want to be Judged <<--- or --->> No, for exhibition only
(circle selection above)

Signature____________________________________Date_______________________

By Submitting this application, I release all parties associated with the event including, but not limited to California Concours d’ Automobile, the City of Long Beach, their agents and employees from any and all liability, injury and damage arising out of my participation in said event.

For Additional information please call: Maurice Khawam 562.429.7151