Busti Fire Department Inc. Pumpkin Hurling 2003


Machine Name 			______________________________

Builder				______________________________ 

Crew				______________________________

Sponsor				______________________________ 

Class				______________________________

Contact Name			______________________________

Address				______________________________

Phone				__________________

E-mail				______________________________

Any Special Needs	________________________________________________________________________


I hereby agree to hold Busti Fire Department Inc. harmless from all accident or
injury resulting from Pumpkin Hurling activities on October 12th, 2003.


Signed	______________________________________________________