Surf City Car Show Registration

1. Contact Information

First Name

Last Name

Mailing Address

Apt/Suite/Office

City

State

Postal Code

Email Address

Phone Number

Mobile Phone

2. Please check which day you would like to enter Required Question

	Saturday, September 18, 2010 - Classic Cars & Trucks
	Sunday, September 19, 2010 - Lowriders, Corvettes, Tuners, & PT Cruisers

3. Vehicle Year Required Question

4. Make and Model Required Question

5. Category Required Question

	Stock
	Modified

6. Payment information - $10 entry fee per car. Entry fee proceeds go to Angels Anonymous of Lincoln City. Required Question

	Check - mail to: Chinook Winds Casino Resort Attn. Rudy Shuping 1777 NW 44th St. Lincoln City, OR 97367 (include response ID # issued upon completion of online registration).
	Credit Card - complete below

7. Credit Card Type

8. Name as it appears on Credit Card (must match name from contact info above)

9. Credit Card Number

10. Credit Card Exp. Date