Application

September 8th - 9th, 2012 at the historic Salisbury House & Gardens, Des Moines, Iowa

Fill out the form below or download a printable version of the application and mail it to:

Salisbury House & Gardens
4025 Tonawanda Drive,
Des Moines, Iowa 50312

Download

 

Owner: A value is required. Spouse/Guest:

Address: A value is required.

City: A value is required.State: A value is required.Postal Code: A value is required.Invalid format.

Home Phone: A value is required. Work Phone:

Cell Phone: E-mail: A value is required.Invalid format.

Vehicle Information (Automobile, Motorcycle, or Other) (to the extent available)

Year: A value is required. Marque/Make: A value is required.

Model: A value is required.

Coachwork by (if applicable):

No. of Cylinders:

Description:

Please provide information for selection committee and spectator interest. Because we focus on the beauty of the vehicle, we are particularly interested in design information such as designer, significant styling and craftsmanship details, and design history of the model. Other information is less important but also welcome, such as awards, special recognition, restoration work completed, purchase/ownership experience, notable ownership or race history, etc.

A value is required.

This information will be used for the program description and will be edited to fit space available.

Participation: please indicate for our general planning your interest in the following if your automobile is accepted for exhibition. Details will be confirmed following acceptance.

Saturday Driving Tour & Lunch: # attending.

Saturday Evening Exhibitors' Banquet: # attending.

Sunday Awards Reception: # attending.

Photo

Please a photo of your vehicle. If your application is accepted, the photo will be published in the event program, so the photos should not include signage or people. Good lighting and a pleasant background are helpful.

IMPORTANT! Your file must be 2MB or smaller or it will not be sent.

Picture Attachment:

Please make a selection.

AGREEMENT & WAIVER


IMPORTANT – acceptance is conditional upon signing this AGREEMENT & WAIVER:


In consideration of acceptance to the Salisbury Concours d’Elegance ("Concours"), the undersigned agrees as follows:

  • I agree to provide proof of vehicle liability insurance and a valid driver's license to the Salisbury House Foundation (SHF) in advance of the Concours event.
Insurance Carrier   Policy #   Expiration
   
         
Drivers License #   State of   Expiration
   
  • I agree to place a fire extinguisher behind the left front wheel of my vehicle while on display.
  • I will indemnify, defend and save harmless SHF, its committees, staffs, directors, volunteers and agents from and against any and all liability, claims, damages, costs and expenses (including reasonable attorneys fees) in connection with my participation in the Concours which result from my negligence.
  • I acknowledge that the indemnified parties above assume no liability for stolen or damaged property and agree that I display my vehicle at my sole risk, and I waive all claims against the indemnified parties for damages to my vehicle except those which result from the negligence of an indemnified party.
  • I give permission and free unconditional non-exclusive license to SHF to use my name and images of my vehicle for promotional or educational purposes in connection with the Concours (whether before, at, or after the Concours event).

All provisions of this AGREEMENT & WAIVER apply to participation in all events related to the Concours. I understand that proof of liability insurance will be required upon approval of my entry.

I have read, understand, and accept the Agreement & Waiver: Please make a selection.

We will typically reply within 1 or 2 days acknowledging receipt of your application.

If you do not receive a prompt reply, please contact Katie Wengert at kwengert@salisburyhouse.org by e-mail or call 515-274-1777.

 

 

Salisbury House & Gardens, 4025 Tonawanda Drive, Des Moines, Iowa 50312
www.salisburyhouse.org Phone: 515.274.1777 Fax: 515.274.0184