Back to the Bricks
Westside Tour (6th ANNUAL)
TOUR 2015
JUNE 12 – 16, 2015
All individuals with street legal automobiles or trucks are invited to join the 6th ANNUAL BACK TO THE BRICKS
WESTSIDE TOUR 2015. You can travel the entire tour, attend any portion of it and/or go to any recommended stop(s)
along the way. Handing out and discussing BACK TO THE BRICKS 2015 promotional information IS OPTIONAL.
Providing for your own food, equipment, hotel and any/all other individual expenses that incur throughout, for and during
the tour, is the participant's responsibility. Participants of the tour are recommended to comply with all local laws, speed
limits, etc. All Participants, please try to get all forms in NO LATER THAN June 4, 2015 to be included in the count
that is reported to Tour Stops. Participants can sign up along the tour.
NAME OF VEHICLE OWNER(S): ______________________________________________________
NUMBER OF OCCUPANTS IN VEHICLE: _____ HOME #: ____________CELL #________________
ADDRESS, CITY, STATE, ZIP: ________________________________________________________
________________________________________________________________________________
YEAR: __________VEHICLE MAKE: ___________________ MODEL: _______________________
TYPE OF VEHICLE: __HOT ROD __LOWRIDER __TUNER __MUSCLE CAR __ORIGINAL
__RESTORED __TRUCK __STREET ROD __OTHER (Please Specify):_______________________
SPECIAL NEEDS (Handicap Accessibility, Vegetarian, Allergies, Etc., Please Specify): ____________
_________________________________________________________________________________
EMAIL ADDRESS: ____________________________________________________________________
RELEASE OF LIABILITY: It is agreed that your vehicle meets and exceeds the State of MI Dept. of
Transportation’s safety requirements and that your vehicle is fully insured and licensed. It is also understood that
your vehicle and participants will take full responsibility of any damages that may result from careless operation of
your vehicle or an unfortunate incident that occurs at a Tour Related Event and hold harmless the BACK TO THE
BRICKS committee, promoters, sponsoring organizations, accommodations facility, clubs, affiliates, spectators,
others and/or to yourself at any of the locations in relation with the BACK TO THE BRICKS WESTSIDE TOUR. This
form will stay confidential with the Back to the Bricks Committee .
Insurance Co. _________________________ Policy No. ____________________ Expiration: ________
VEHICLE OWNER 1 SIGNATURE:
PASSENGER (or Owner 2) SIGNATURE
________________________________
DATE: _______________
________________________________
DATE: ______________
Check #___________ Date
CC____ Date
Back to the Bricks
Westside Tour (6th ANNUAL)
TOUR 2015
ATTENDANCE SHEET
Please indicate if your vehicle and participants will be attending all events or certain events below.
All details will be in Tour Agenda.
All stops are overnight.
Mark one or many:
June 12 – 16, Attending All Events Listed Below ______
---- ----- OR ---- ---June 12 – Friday, Tour Send off in Flint to Battle Creek______
June 13 – Saturday, (Leave Battle Creek) Whitehall______
June 14 – Sunday, (Leave Whitehall) Manistee _____
June 15 – Monday, (Leave Manistee) Boyne City______
June 16 – Tuesday, (Leave Boyne City) West Branch______
June 17 – Wednesday, End of the Road Party East Tawas______
VEHICLE OWNER SIGNATURE: __________________________________________ DATE: _____________
Back to the Bricks
Westside Tour (6th ANNUAL)
TOUR 2015
ORDER FORM
No. of _______ 1- WESTSIDE PROMOTIONAL TOUR PACKET for $40:
PACKET INCLUDES: Tour Agenda/Itinerary, 2- Name Lanyards, 2- T-shirts
(Sizes: ___ ___), 1 - 3in x 3in Participant Window Cling
Total: $______
ADDITIONAL TOUR ITEMS
No. of _______ T-Shirts –for $15 Each:
_____S _____M _____L ____XL ____2XL ____3XL
Total: $______
No. of _______ Name Lanyards for $10 Each
Total: $______
Additional Names: ___________________________________________
__________________________________________________________
Order Grand Total: $_________________
Please make checks payable to: BACK TO THE BRICKS. Please send entire application to:
Back to the Bricks, Inc.
7377 New Hampshire Drive
Davison, MI 48423
You can also purchase a Participant Packet at the Back to the Bricks Office at specified times
to be determined.
Packets will not be mailed. The packets can be picked up along the Tour Route and the locations
below (check the schedule page of our website for more locations: www.backtothebricks.org) or
www.facebook.com/backtothebricks
.
Back to the Bricks
Westside Tour (6th ANNUAL)
TOUR 2015
Back to the Bricks, Inc.
7377 New Hampshire Drive
Davison, MI 48423
One Time Credit Card Payment Authorization Form
Sign and complete this form to authorize Back to the Bricks, Inc to make a one time debit to your credit
card listed below.
By signing this form you give us permission to debit your account for the amount indicated on or after the
indicated date. This is permission for a single transaction only, and does not provide authorization for any
additional unrelated debits or credits to your account.
Please complete the information below:
I ____________________________ authorize Back to the Bricks to charge my credit card
(full name)
account indicated below for _____________ on or after ___________________. This payment is for
(amount)
(date)
Registration for the 2015 Back to the Bricks Westside Promotional Tour.
(description of goods/services)
Billing Address ____________________________
Phone# ________________________
City, State, Zip ____________________________
Email ________________________
Account Type:
Visa
MasterCard
AMEX
Discover
Cardholder Name _________________________________________________
Account Number
_____________________________________________
Expiration Date
____________
CVV2 (3 digit number on back of Visa/MC, 4 digits on front of AMEX) ______
SIGNATURE
DATE
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment
authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an
authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the
terms indicated in this form.
Back to the Bricks
Westside Tour (6th ANNUAL)
TOUR 2015
PARTICIPATION PACKET PICKUP
Packets will be available June 3 @ 3PM BttB Office
4400 S Saginaw St, Flint, MI
June 9 @ 5PM at Dukes on Miller Rd
Please check www.facebook.com/backtothebricks for more pick up locations, this form may be
updated also.
Day of Departure: June 12, 8am – 9:00am, IINN, 4500 South Saginaw Street,
entrance on Hemphill Rd.
Between Hemphill and Atherton Roads (Southwest corner).
For Additional Pickup Dates and Locations prior to June 12:
please check the schedule page of our website: www.backtothebricks.org or
www.facebook.com/backtothebricks
We advise participants to bring certain items such as:

 Necessary tools
 Jumper cables
 Oil, Coolant, etc.
 Flashlight
 Fire extinguisher
 Cellular phone and charger
Also, remember to buddy up with a few other couples in case of any issues getting lost,
etc., to exchange phone numbers
1/18/15 ver 1.2