Experience Registration 2023 Experience registration form Experience 2023 Registration First Name * Last Name * Email * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Experience Registration $80 * Please Select Number of People 1 2 3 4 5 6 7 Each Person attending must include an Experience registration. Friday Evening English BBQ $65 Please Select Number of People 1 2 3 4 5 6 7 Friday Symphony Chamber Orchestra $30 Please Select Number of People 1 2 3 4 5 6 7 Saturday Evening Banquet $95 Please Select Number of People 1 2 3 4 5 6 7 Sunday to Tuesday Driving Tour $75 Please Select Number of People 1 2 3 4 5 6 7 Attendee 1 Name * Attendee 1 Name First First Last Last Attendee 2 Name Attendee 2 Name First First Last Last Attendee 3 Name Attendee 3 Name First First Last Last Attendee 4 Name Attendee 4 Name First First Last Last Attendee 5 Name Attendee 5 Name First First Last Last Attendee 6 Name Attendee 6 Name First First Last Last Attendee 7 Name Attendee 7 Name First First Last Last Would you like to register a car for the event? * Yes No Each car registration is $60. Vehicle Entry Form Inviting all Full Classics and European Luxury Vehicle Type * Full Classic Non-Classic Owner’s Name * Owner’s name as you would like it to appear on customized license plate. Owner’s City & State Year * Make * Model * Cyl Serial # Body Style * Custom Body Builder Color Insurance Co. Policy Number Expiration Date Distinguishing Features Please list interesting background information about your car: Please upload a photograph of your car or email it to cvogt@ccamuseum.org Drop a file here or click to upload Choose File Maximum upload size: 5MB * I agree to terms and conditions Rules of Entry:Recent photograph must accompany your entry or email photo to cvogt@cccamuseum.org.Cars must be in place before 9:00am on June 3, 2023 and remain in position on the Concours display area until the final award is presented. The first 75 entrants with car in attendance will receive a collectible license plate. The deadline for customized plate is May 1, 2023. “For Sale” or other commercial signs are not allowed. Neither vendors nor photography for commercial purpose are permitted.Waiver of Claims and IndemnityIn consideration of participation by the undersigned in the Classic Car Club Museum Experience on June 5, 2023, the undersigned agrees that the information above is correct and to the extent not prohibited by law, to indemnify, defend and save harmless the Classic Car Club of America Museum, the Gilmore Car Museum, the Classic Car Club of America and each of their trustees, officers, directors, employees and agents (individually and collectively the (Released Parties) from and against all liability, claims, damages, costs and expenses in connection with the undersigned’s participation in the event which result from the undersigned’s fault or neglect. Further, the undersigned acknowledges that the Released Parties assume no liability for stolen or damaged property of the undersigned and the undersigned agrees that he/she is displaying his/her car at his/her sole risk and, to the extent not prohibited by law, the undersigned waives all claims against the Released Parties for damages to the undersigned’s car at the Event resulting from any occurrence on the Classic Car Club Of America Museum/Gilmore Car Museum grounds. In addition, the undersigned will personally read the rules and regulations for the Event and abide by said rules and regulations. The undersigned authorizes the Event to use the photograph and information about the motorcar accompanying each entry for publicity purposes, and certifies such use does not infringe upon the rights of any third party, that the right is granted free and clear; and that the entrant has full power to grant such rights. The undersigned further consents to the use of photographs or depictions of him/her or his/her automobile(s) in any other media, and further agrees that any such media presentation may not be used for commercial purposes and warrants that any photographs, video or motion picture films of the Classic Car Club Museum Experience for commercial use must have prior written permission from the Executive Committee. TOTAL If you are human, leave this field blank. Continue to Payment