Event Registration Form         9th annual   "Mid-West USA Regional"
September 5&6   2008     Bethany, OK
This event is hosted by "the Wayfaring Cruisers" PT Cruiser Club.
We are an Oklahoma Chapter of the National PT Cruiser Club (PTCC) located in their South Region.
This event is sanctioned by the National PT Cruiser Club.
Early Pre-Paid Registration Includes:
Event entry for vehicle and passengers / 1 goody bag / 1 dash plaque / 1 coupon for awards dinner, / 5
tickets for a special drawing at the event / access to all event activities / eligibility for quality door prizes /
entry for car and light show / entry for special activities / and more
Your name:____________________________________________________________________________________________

Additional attendees:____________________________________________________________________________________
(First and Last Names)

Address:______________________________________________________________________________________________

Telephone: ___________________ Club affiliation:___________________________________________________________

Vehicle info: ___________________________________________________________________________________________
**Please print out this registration form, fill in all information, and sign and date the release.**
"Mid West USA Regional " event release
By signing this form I hereby release and discharge from all liabilities ( known or unknown,
injuries, losses, judgments, and/or claims resulting from the conduct of participants and spectators), the event management,
the PT Cruiser Club, the Wayfaring Cruisers PTCC chapter, and all sponsors and any event vendors.


signed:___________________________________________________ date:___________________ total in party: _________

You will receive 1 awards dinner coupon included with your early pre-paid registration. Additional coupons may be purchased.

Event shirts are available for purchase if desired.

Event shirts are not included in registration fee in order to offer a lower registration fee this year to all registrants.
Early Pre-paid Vehicle Registration Fee : $40.00

Registrations Received after 8/18/08:       $48.00
(No orders for shirts after 8/18/08)


Event shirts (if desired)
qty. ______ size _________ (S -XL) $10.00 ea.

qty. ______ size _________ (2XL -4XL) $12.00 ea..

Additional dinner coupons (if desired)
qty. _____ adult @ $10.00 ea.

qty. _____ child @ $5.00 ea.
$ 40.00    Vehicle Registration Fee (before 8/18/08)

S______    cost of event shirts ordered (if any)

$______    cost of extra coupons ordered (if any)

___________
$                    Total Registration Cost
Please make your check or money order payable to:
"The Wayfaring Cruisers PT Club"

mail to: Richie Reynolds
                     14443 S Vandalia Ave
             Bixby, OK 74008