Form version 2/07/2003

The following Owner/Driver commitment/release statement, in its entirety, must be included in all VMCCA National, Region and Chapter tour or meet registration forms as per VMCCA Board of Governors Directive. 

VMCCA OWNER/DRIVER COMMITMENT/RELEASE STATEMENT

Owner _______________________  Driver (if different) ____________________________

Address_________________________________________________________________

Vehicle:  Year ________ Make ______________________________________________

Engine or serial no. ______________ State Registered in (domicile state) ____________

License number ______________________

   I hereby agree to enter the vehicle described in the Veteran Motor Car Club of America ____(name of event)____. In consideration of the right to enter this event and for other valuable considerations, I (we) do hereby agree to indemnify, protect, defend and hold harmless The Veteran Motor Car Club of America and its Chapters and/or Regions, Officers and Representatives from and against any and all claims, costs, liabilities and attorneys' fees arising from damage or injury, actual or claimed, of any kind or nature, to property or persons, resulting from my (our) participation in the ____(name of event)____.

   The owner/driver has proof of bodily injury and property damage liability insurance on the entered vehicle in the amount of at least $100,000 per person, $300,000 per accident bodily injury liability and $100,000 property damage liability, or $300,000 combined single limit liability insurance.  Insurance company name ___________________________________, policy no. ___________________, policy term (dates) _________ to ____________.

   The owner/driver certifies that the described vehicle entered in this event has duly passed the requirements of the motor vehicle authorities, or other governing bodies of the state in which the vehicle is registered, and the vehicle shall be legally registered and/or licensed.  The Veteran Motor Car Club of America and its representatives will not, and cannot, be held responsible for the "safety certification" of any participating vehicle.

Signed ________________________________  ______________________________________

                                 Owner                                                         Driver (if different)

Date    __________________________              ____________________________