History in the Making 2023 Car Show Registration Form

Car Show Registration Form

See you in Selma on May 27th!
Car Owner Name*

First NameLast Name
Car Owner Phone Number*
Please enter a valid phone number.
Car Owner Email*
example@example.com
Car Owner Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company/Organization Name
Car Details
Car Make*
Car Model*
Year*
Color*
Current Mileage
Is this a modified vehicle?*

YesNo
If yes, please provide the details about the modifications
Are you a member of any exclusive car club?*

YesNo
If yes, what is the name of the car club?
Payment Details
Car Owner Signature*

Clear
Date Signed*

MonthDayYear
Date
My Products
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* Early Bird * Vehicle RegistrationRegister before April 8, 2023, and enter your vehicle for HALF PRICE! Vehicles are limited to those produced in 1990 or before. Have two cars? That's two entries for the price of one ONLY if you enter before April 8th!
$10.00 Quantity



Vehicle Registration FeeCost per vehicle. Vehicles are limited to those produced in 1990 or before.
$20.00 Quantity



Levitt AMP Selma T-ShirtWant to stand out in our Levitt AMP Selma 2023 t-shirt? Get yours here!
$20.00 Quantity



Total

$0.00
Should be Empty: