Registration for 2017 Bandit Run 2017 Registration (June 17th - 24th)Again this year, at each stop of the Bandit Run, we will be doing a special raffle to win prizes & raise money for Charity! **Hotel info will be provided after registration.** We will be raffling everything from tires, clocks, shirts, mugs, decals and much more! The sponsors have provided many great prizes for a good cause. All money towards raffle tickets purchased, along with donations, will be given to Camp Quality USA. Camp Quality serves children with cancer and their families by providing year-round programs, experiences, and companionship at no cost. Camp Quality promotes hope and inspiration while helping children foster life skills and develop their full potential. To Learn More Click Here http://www.campqualityusa.org/ Participant package good for one vehicle & driver. You must purchase a package for each additional adult/passenger in your vehicle, and they will receive the same packet. The only exception is that children under 12 are FREE with paid participant. The cost of registration is the same no matter how many days you choose to participate. DRIVER PACKAGE INCLUDES: ($100) BR T-Shirt BR Wristband BR Official Decal for Vehicle Access BR Application Access for Mobile Devices (email address required) Hotel Discount Codes* (email will be sent with all hotel information once payment is received) Event Access at Stops PASSANGER PACKAGE INCLUDES: ($80 with Driver Registration Only) BR T-Shirt BR Wristband BR Application Access for Mobile Devices (email address required) Event Access at Stops For additional swag (commemerative maps, shirts & decals), please visit our online store: http://store.restoreamusclecar.com *Some events will require an additional admission fee not included in registration. All events are subject to change. As of May 10th, registration will increase. Packets will be available from RAMC trailer during the Run.Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Home PhoneMobile Phone while on the Run*Driver Email* Enter Email Confirm Email Shirt Size of Registrant*Shirt SizeSMLXLXXLXXXLPassenger InformationHow many additional passengers in your car? (Not including driver)*0123Passengers DOES NOT include driverPassenger 1Name* First Last Email Cell Phone Number*Shirt Size*Shirt SizeSMLXLXXLXXXLPassenger 2Name* First Last Email Cell Phone Number*Shirt Size*Shirt SizeSMLXLXXLXXXLPassenger 3Name* First Last Email Cell Phone Number*Shirt Size*Shirt SizeSMLXLXXLXXXLOther InformationHow many minor ( under the age of 12) passengers in your vehicle?*01234What is the year, make, model, and color of the car you are planning to drive on The Bandit Run?What is the license plate state and # of the car you are planning to drive on The Bandit Run?What stop are you joining the group?*Texarkana, TXGreenville, MSTupelo, MSBirmingham, ALAtlanta, GAHow many miles do you have to travel to get to your starting point?*Is this your first time joining The Bandit Run?*Yes, it isNo, it isn'tAdditional Notes or Contact InformationPayment InformationPayment Method*Online (PayPal)Mail in checkCall in Credit Card InfoMail Checks to: RAMC c/o Bandit Run 11850 N. 56th St. Lincoln, NE 68514 -- Call in Credit Cards at 402.465.5756Registration of Driver Price: $ 100.00 Registration Package for Passengers in car* Price: $ 80.00 Quantity: Quantity includes all adults (over the age of 12) passengers who are on this registration form, except for the driver. Quantity does not include any child passengers. If you do not have any passengers, please add a 0.Total $ 0.00 Waiver FormIn consideration for my participation in THE BANDIT RUN 2017© I submit the following information and agree with the Organizers identified below to the terms and conditions of the event set forth here. I warrant that I have fully considered the terms and conditions below, whereby I will participate in THE BANDIT RUN 2017© and fully agree to the same. I will take responsibly for my actions and agree to act responsibly at all times. I also agree to let myself, my family and my car be photographed and/or videotaped with the understanding that all accounts of the event, photographs and videotapes become the property of Restore A Muscle Car LLC., and its assigns and may be may used by Restore a Muscle Car LLC in any advertising, broadcast, publication, catalog or on the Internet without my further permission. I have read understood and accepted these terms and conditions and acknowledge that they shall be effective and binding. THE BANDIT RUN 2017© TERMS AND CONDITIONS FOR PARTICIPATION. In consideration of Participant's involvement in THE BANDIT RUN 2017© which includes the “Bandit Run” caravan and all other events, sanctioned and not sanctioned by the ORGANIZERS identified below, the receipt and sufficiency of which is expressly acknowledged, Participant warrants, understands and agrees to the release of liability, covenants not to sue and the hold harmless and indemnification agreements set forth herein as follows: Events in any form and especially involving automobiles such as The Bandit Run 2017© are inherently dangerous action sports, carrying with them the significant risk of serious personal injury, death and property damage. Those and other risks are substantially increased by conditions and risks posed by third parties whether participating in the event or not. The elements of nature, mechanical and environmental conditions and risks and other factors, which are beyond the control of the ORGANIZERS, may, independently or in combination with the ORGANIZERS related activities, cause property damage or injuries to the Participant. The ORGANIZERS, and the various facilities and environments at which any activity is held cannot control or supervise the activities of Participants or others in all circumstances and, as a consequence, Participant may be at those risks unknown at this time. Participant understands that as a condition to his/her participation in the event, Participant shall, at all times be required to exercise all care for his/her own safety and the safety of others, and shall abide by and conduct him/herself in a manner consistent therewith. Participant shall be solely responsible for procuring and wearing the appropriate safety equipment, including (without limitations) head, eye and other protective gear. Participant acknowledges that Participant is solely responsible for his/her own safety. Participant, defined as the parties signing this agreement and any person associated therewith and participating in the event, including but not limited to him/her self, spouse, heirs, minor children, assigns, related individuals and related entities, does hereby release, waive, absolve, discharge and agree to hold harmless the ORGANIZERS, including all representatives, officers, directors, employees, agents, affiliates, insurers and others (collectively, the "ORGANIZERS"), from and against any and all rights, claims, demands, causes of action, obligations, suits, liens, damages or liabilities of any kind and character whatsoever, whether known or unknown, suspected or claimed, which Participant shall or may have in the future against the ORGANIZERS arising out of, based on, related to or connected with Participant's participation in any ORGANIZERS activities. Participant also agrees to indemnify and hold the ORGANIZERS harmless from the payment of any and all judgments, settlements, costs, disbursements and attorney fees that are associated with the ORGANIZERS having to defend or investigate any claim, action or proceeding of any type whatsoever arising out of Participant's participation in any ORGANIZERS activities including, but not limited to failure to warn, negligence (whether caused by the sole negligence of the ORGANIZERS, the concurrent negligence of the ORGANIZERS with Participant or any other person, or otherwise), strict liability, or otherwise. Participant understands that if any circumstance or understanding effecting the Participant’s election to sign this form is later found to be other than or different than now believed by Participant to be true, Participant expressly accepts and assumes the risk of such possible difference and agrees that this form shall be and remain effective notwithstanding such difference. Participant covenants and agrees not to sue or institute, prosecute, maintain, proceed on, or assist with a suit which arises out of, or may be, in whole or in part, based upon, related to or connected with the released matters herein or any part of them. Participant further covenants and agrees that in the event that Participant is injured during a related activity, Participant is responsible for the treatment of any injury. The ORGANIZERS do not undertake any authority or obligation to arrange for treatment, transport to a hospital or other medical facility for further medical attention. Participant understands and agrees that the ORGANIZERS are not responsible for providing insurance of any kind and Participant represents and warrants that s/he has sufficient medical and accident insurance that will be maintained throughout the entire period of Participant's participation in the event and related activities, to cover all costs of medical care and treatment required as a result of any injury or accident. Participant acknowledges that this Agreement is executed in exchange for the opportunity to participate in the event and event related activities which is the agreed upon consideration. This agreement shall be governed only by the laws of Nebraska and that the forum for any action against the ORGANIZERS shall be proper only in Lincoln, Nebraska. Participant waives any punitive damages of any kind or nature and waives trial by jury and agrees that damages for any claim that is successful shall be limited to the entry fee paid by Participant for the event. THANK YOU FOR PARTICIPATION IN THE BANDIT RUN 2017© This year’s Organizers are: Restore a Muscle Car, LLC* By checking this box I state that I have read the waiver form and agree to its conditions.