Shine On Car Rally Registration

Or register online below:

Drivers Name*
Drivers Telephone*
Drivers Address*
Street Address Address Line 2 City Province Postal Code
Drivers Email*
Navigator Name
Navigator Telephone*
Navigator Address*
Street Address Address Line 2 City Province Postal Code
Navigator Email*
Vehicle (Year / Make / Model)*
Licence Plate #*
Car Rally Entrance Fee*
Price: $ 75.00 CAD
Includes entry for driver and a navigator
Back Seat Driver
Price: $ 25.00 CAD
Prce per person
Total
$ 0.00 CAD
Select Payment Method*
If paying by cheque please make cheques payable to the Rotary Club of Stratford and mail completed forms to: Stratford Perth Museum- Shine On 4275 Huron Road, RR 5, Stratford, ON N5A 6S6 OR you can pay by electronic transfer to finance@rotarystratford.com Please make your payment type selection below:
Credit Card

Discover
MasterCard
Visa
Supported Credit Cards: Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name