Shine On Car Rally Registration - Stratford Perth Museum

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 Quantity:

Includes entry for driver and a navigator

Back Seat Driver

Price: $ 25.00 CAD Quantity:

Prce per person

Total

$ 0.00 CAD

Select Payment Method*

Credit Card

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name