Vehicle 1

Year (from 1900 - 1999): ___________

Year (from 2000 - 2019): ___________

For vehicles between 2000 and 2019 - we will need a description and photo.
Please note: We have limited space on the field, and have limited space for each class.

Make: ___________________ Model: _____________________

Licence plate number _______________________

Name on Ballots:____________________________________

Name on Dash Card:_________________________________

Club Name if parking in Club parking: ____________________________________
Confirmation package will be mailed out for Club Parking area after 10 or more preregister from your club.
Arena Car
Arena Car photos (we will need a photo and description)
(we will send the photos and info below to the arena committee with your photos)

$35.00 Price includes vehicle & 2 people for the weekend $40 at the gate

Extra People?
Weekend Armbands (Kids 12 & under are free with a paid adult) $20/weekend - Quantity: ____ Amount: $______
Day Passes (Kids 12 & under are free with a paid adult) $12/day                     Quantity: ____ Amount: $ ______

Tickets on the New Hamburg Optimist's 2017 ticket car a Dodge Challenger

Tickets must be purchased in Ontario or may be purchased while registering your vehicle

Single tickets $5 each
Name of the person on the tickets: _______________________ $5 each Quantity: ____ Amount: $ ______
Set of 5 tickets for $20/set
Name of the person on the tickets: _______________________ $@ $20 Quantity: ____ Amount: $ ______

Vendor Registration - please call 519-342-1284

Billing, Mailing and Delivery Information:
COMPANY NAME:____________________________________ Your NAME: ____________________________________
ADDRESS: ________________________________________________________________________
CITY:________________________ PROVINCE/STATE: ______ POSTAL CODE: ______________
PHONE (WITH AREA CODE): _____________________________
EMAIL ADDRESS: ____________________________________
METHOD OF PAYMENT Cheque Visa  MasterCard              Total Amount to charge to my card $______________
Name of the person on the Credit Card: _____________________________________
Card Number: ___________________________________ Expiry Date: _____/______

Make cheque out to & mail to:
57 Pinehurst Cres
Kitchener ON N2N 1E3