Our upcoming show will be held on August 11th, 2012. 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)

Registration is $15.00 for the first truck and $5.00 for each additional truck. Registration for Charter Members 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. Use back of page for additional trucks.

( ) Check here if using back of page

( ) Check here if Charter Member

Year Model Body Style
Amount



$ _____



$ _____



$ _____



$ _____

Subtotal:

Pre-Show Pork Roast Buffet Fundraiser Registration (Reservations Required)

Register now for the Pork Roast Buffet on Friday, August 10, 2012, 5 to 8 p.m. @ $25.00 each. Catered by Bob's BBQ'.
#People__________  X  $25.00 each = Amount $ _______

Chicken BBQ Registration (Former Brockway Employee Recognition) (Reservations Required)

Register for the chicken barbeque on Saturday, August 11, 2012, 5 p.m. @ $20.00 each. Catered by Cortland Co. 4-H Board
#People__________  X  $20.00 each = Amount $ _______

Sponsor of Spectacular Fireworks Display on Friday evening - $250.00 - name listed in program book - deadline June 1, 2012

Amount $ _______

Grand Total

  (add subtotals above for trucks, dinner, bbq, and fireworks)     GRAND TOTAL: $__________

PANCAKE BREAKFAST, SUNDAY, AUGUST 12, 2012, 7 A.M. TO 11 A.M. AT THE MUSEUM. PAY AT THE DOOR.

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):