Our upcoming show will be held on August 14th, 2010. If you would like to be part of the show and show off your Brockway truck,
please fill out the form information and mail with payment to the address below. Please make checks payable to: Brockway Truck Preservation Association

Brockway Truck Preservation Association
PO Box 333, Cortland, New York 13045

Please tell us about yourself

Full Name:
Email:
  Phone:
Address:
City:
  State/Province:
Zip/Postal Code:
  Country:

Tell us about your truck(s)

Pre-Registration is $10.00 for the first truck, and $5.00 for each additional truck. Your first vehicle will receive a commemorative dash plaque, exhibitor card and program book. All registered trucks will receive the exhibitor card and program book.

Year Model Body Style
Amount



$ 10.00



$ 5.00



$ 5.00

Subtotal:

Pre-Show Pork and Chicken Dinner Registration (Reservations Required!)

Register now for the Pre-Show Pork & Chicken Dinner on Friday, August 13th, 5-8pm at the Museum Site, 4392 Rt. 11 @ $25.00 each. Catered by Bob's BBQ. Pulled pork, BBQ chicken, salt potatoes, baked beans, macaroni salad, coleslaw, brownies, soda and water.
#People__________  X  $25.00 each = Amount $ _______

Chicken BBQ Registration (Reservations Required!)

Register for the Chicken Barbeque on Saturday, August 14th, at 5pm at the Museum Site. $20.00 each.
#People__________  X  $20.00 each = Amount $ _______

Grand Total

  (add subtotals above for trucks, dinner & BBQ)     GRAND TOTAL: $__________

I understand that during the course of my participation in Brockway events, photographs may be taken of me and/or my property.  I hereby grant to Brockway Truck Preservation Association, Inc. and the Homer-Cortland Community Agency, Inc., its employees, agents, successors and assigns, the absolute right and permission to use, and/or publish these photographic pictures of me and/or my property for advertising or any other lawful purpose.

Signature:
Date:
Name (print):