Concours d 'Elegance online applicaiton

Owner's Name*

First Last

Name(s) as they should be displayed*

Address*

Street Address Line 1 Street Addres Line 2 (Apt., Suite, Etc.) City State ZIP Code

Contact Phone Number*

Please Choose one*

Home
Work
Mobile

Email*

Vehicle Information

Year*

Marque / Make*

Model*

Body Style (and coach builder if applicable)*

Original / Altered Body*

Original Body
Re-bodied
Modified
Recreation

If not Original Body, please address reasons and history of alterations.*

Describe any incorrect or modified areas, including non-original parts or modern substitutions (including radial tires or other upgrades.)*

Please confirm or explain if the car maintains its original engine, transmission and colors.*

Engine (configuration, displacement)*

Transmission*

Automatic
Manual

Serial or Chassis Number*

Exterior Color*

Condition*

Preservation
Refreshed
Restored
Modified

Preservation Award Consideration*

Preservation is defined by the Milwaukee Concours d'Elegance as a car having over 50% of its original exterior (paint,wheels), more than 50% of its original trim (interior and top) 70% as of its production date and at 70% or more of the original powertrain with which it left the factory. With that in mind, do you wish to have your car considered for a Preservation Award?

Yes
No

If Modified, please explain*

Judge or Display*

Judge
Display / Exhibit

What is special about your car?*

Please provide a description of 40-60 words about your vehicle to be printed in the commemorative program.

List any awards this vehicle has won throughout its history

Photos*

Please submit 4 photos: 2 exterior photos (one of each side), an interior photo and engine. One of these photos will be used in the commemorative program. Files must be no larger than 20MB.

Drop files here or

Will you bring a trailer?*

Yes
No

Insurance Carrier*

Policy Number*

Policy Expiration Date (MM/DD/YYYY*

Release and Indemnity*

In consideration of acceptance to The Milwaukee Concour, to be held August 4, 2019 (the "Event"), by The Masterpiece, Ltd., the undersigned agrees as follows: 1. To the extent not prohibited by law, the undersigned agrees to indemnify, defend and save harmless The Masterpiece, Ltd, their committees, staffs, directors, volunteers and agents (individually and collectively the "Released Parties") from and against any and all liability, claims, damages, costs and expenses in connection with the undersigned's participation in the Event which result all or in part from the undersigned's fault or neglect. 2. The undersigned acknowledges that the Released Parties assume no liability for stolen or damaged priority of the undersigned and the undersigned agrees that he/she is displaying his/her vehicle 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 vehicle or vehicles at the Event resulting from any occurrence on the grounds of the event except those which result solely from the fault or neglect of a Released Party. 3. The undersigned gives permission and free unconditional license to The Masterpiece, Ltd. to use any images of the vehicle or vehicles and/or its owner(s) and information regarding the vehicle for publishing/promoting/marketing purposes in connection with the Event or future similar events produced by the Masterpiece, Ltd.

I have read the above and accept the terms and conditions.

Owner's Name*

Please review your information carefully before submitting.

Referred by: (Name)

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Email

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Concours d ‘Elegance online applicaiton

Vehicle Information

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Vehicle Information

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