Mopars Unlimited 2009 Show & Shine Registration Form

Saturday, May 16^th 2009 Jefferson Park Richland, WA

ONLY ONE VEHICLE PER REGISTRATION FORM

Name: __________________________________________________________________________

Address: ________________________________________________________________________

City: _____________________________________ State: _______________ Zip: ______________

Phone Number: __________________________

Make & Model of Car: _____________________________________________________________

Year: ____________ License Number: _____________________ Engine Size: ________________

Club Affiliation: ___________________________________________________________________

What car/truck class is your vehicle? Please circle one.

Dodge A-Body Plymouth A-body Dodge B-Body Plymouth B-Body Dodge E-Body Plymouth E-Body

Dodge Truck Modern Mopar RWD 1990+ Modern Mopar FWD 1990+ Mopar Open pre 1990

Non Mopar Modern 1990+ Non Mopar Open pre1990

FEES:

Registration $20.00 per car

Make checks payable to MOPARS UNLIMITED.

Send registration form and fee for each car entered to:

Forest Fincher

8003 Saturna Dr

Pasco, WA 99301

Total Amount Enclosed: $ 20.00

Liability: The Undersigned acknowledges and understands that Mid-Columbia Mopars Unlimited provides NO insurance coverage.

Entrants must be 18 years of age or have signed parent or legal guardian permission.

I have read this application and agree to all conditions to enter in the Mid Columbia Mopars Unlimited car show and shine and to the rules governing the event as set forth on this form and to observe all rules and decisions of event management.

NAME____________________________________________SIGNATURE_____________________________DATE____________

LEGAL GUARDIAN (if applicable)_______________________SIGNATURE_____________________________DATE____________