2010 POCI Convention Registration Form July 6-10, 2010 Charleston, West Virginia

Registration Fee  $49.00     _______ check       __________ cash_____________________________ _credit card

Fee is non-refundable

Name_____        ____________________ POCI Number_______________

Mailing Address________________________________________________

City___________________ State__________ Zip_______

Phone Number__________________         ___ Cell Number,

E-Mail Address___________________________________

Swap Meet Space Requested                  Yes_______

RV Space Requested                      Yes_______

Trailer Space Requested                     Yes________

If Yes, do you have an Open__________ or Closed__________ Trailer

Hotel Reservations are the responsibility of each individual.

Host Hotel will be the: Holiday Inn Charleston House - 600 Kanawha Blvd.

For other hotels, see our Hotel Listing Guide.

Mail this form to: POCI Convention 2010     Attn: Larry Bailey

21 Holly Circle Winfield,WV25213

Call for convention information:             1-800-235-POCI

Activity Packets will be mailed by March 15, 2010.

OPERATION: Event management reserves the right to deny admission to any persons at management's discretion. Objectionable conduct or appearance, as determined solely by events management, will result in eviction of the entrant and vehicle, such behavior may include unnecessary tire spins, distribution of unapproved printed matter, gang or biker related apparel or any other activity or thing which in the opinion of the management may be detrimental to the public image of the convention. In case of any eviction, the POCI Convention shall not be liable for refunds of any fees or admissions paid.

LIABILITY: In consideration of acceptance of this entry and the right to participate, entrant(s), on entrant's own behalf and on behalf of entrant's guests and participants does hereby unconditionally agree to fully release, discharge and hold harmless the POCI, the Almost Heaven Region of POCI, the City of Charleston-West Virginia, the state of West Virginia, Kanawha County, their officers, directors, employers, agents representatives, servants and anyone else connected with the management or presentation of the POCI convention of and from any and all known or unknown damages, injuries, losses, judgments, and/or claims from any cause whatsoever that may be suffered by entrants to their person or property and the person of entrant's guests and participants. Further, each entrant expressly agrees to indemnify and hold harmless all of the foregoing entities, firms, persons and bodies of and from any and all liability occasioned or resulting from the conduct of entrant, their participants or guests, or cooperating with entrant or under the direction or control of entrant which may cause injury to the person or property of others while in attendance or participating in the activities of the POCI. Entrants agree that participation in any contest, games or activities may be limited to vehicles which have completed the POCI Convention Vehicle Safety Inspection, however, entrant acknowledges and agrees that entrant is in no way relieved of liability nor does POCI Convention assume any liability of any kind or nature whatsoever upon performing a safety inspection. Entrant, on entrant's own behalf and on behalf of entrant's participants or guests, acknowledges and agrees that in the event of any claim or controversy arising between entrant and POCI Convention that this agreement has been entered into in Charleston, Kanawha County, West Virginia, and that any and all claims or controversy shall be under the jurisdiction of the West Virginia Courts in Charleston, Kanawha County, West Virginia.

I acknowledge that I have read the above statement and herby agree

Check made payable to: "POCI Convention 2010"                                   (Signature)