2012 Reg Form Final

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					                                                                   6th Annual Shelbyfest
                                                                   2012 Pre-Registration Form
                                                                   Deadline April 11, 2012
Participant Name: _________________________________ Cell Phone Number: _________________________
Guest Name: _________________________________ Guest Name: _________________________________
Guest Name: _________________________________ Guest Name: _________________________________
Address: __________________________________ City: ___________________ State: _______ Zip: _______
1st Email _____________________________________ 2nd Email _____________________________________

Registration (per car) ---------------------------------------------------------------------------                        _____ X $25.00 ________

Show Car 1 Information: Year ___________________                        Model: __________________________________________
Show Car 2 Information: Year ___________________                        Model: __________________________________________

Zipline: Must be Pre-Registered by April 11, 2012 (Per Person)                                              -------       _____ X $65.00 ________
You will need to be at the Wine Valley Inn Courtyard at 9:00AM on Friday, April 27th to get your PRE-REGISTRATION TICKETS. We will
leave the Wine Valley Inn at 9:30 AM.


Pancake Breakfast: (Chris Cakes) 8am to 10:30am Saturday ONLY (Per Person)                                                _____ X $5.00 ________

Banquet Dinner: MUST BE A PAID PARTICIPANT ---------                              Choice of Vegetarian, Beef Brisket, Grilled Chicken Breast,
Caesar Salad, Homemade Dinner Rolls, Mashed Potatoes, Gravy. Green Beans, Corn, Double Layer Carrot Cake, Double Layer Chocolate Cake

Chicken _______               OR        Beef ________                                       Adult Dinner                  _____ X $15.00 ________
                                                                                            Vegetarian Dinner             _____ X $15.00 ________
Chicken _______               OR        Beef      ________                                  Child (12 & Under)            _____ X $10.00 ________

Pub Crawl -----------------------------------------------------------------------------------------------                 _____ X $20.00 ________

Show T-Shirts Youth: (S) ________ (M) _________ (L) __________                                                            _____ X $18.00 ________
Show T-Shirts Adult: (S) _____ (M) _____ (L) _____ (XL) _____                                                             _____ X $20.00 ________
Show T-Shirts Adult: (XXL) _____ (XXXL) _____ (XXXXL) ______                                                              _____ X $23.00 ________

                                                                                                                              TOTAL        __________
Please Make Checks Payable to: Shelbyfest
Send checks and registrations to:                                      If using PayPal, please add 3 percent. Our PayPal ID is
Shelbyfest                                                             ShelbyfestInfo@gmail.com
103 Hoffman Ave.
Rhineland, Mo. 65069                                                   Signature: _________________________________________
                                                                       Check # ______ Your Paypal ID: _______________________

      ALL CARS MUST BE REMOVED FROM THE SHOW ROUTE BY 6:00 AM SATURDAY MORNING
                             INCLUDING PARTICIPANTS’ CARS

                                     Shelbyfest 2012 is April 27th through April 28th
When you register for Shelbyfest, we assume that you understand and agree that you have given your “informed consent” to handle your personal information in
a secure manner and that any information provided will never be disclosed to a third party or used for any purposes other than for the registration of this event
and communication of information and details regarding Shelbyfest and its associated activities. Your PayPal ID is used for verification purposes only.

				
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