Print, fill out by hand and mail with a check or M/O of $15CDN per entry to

Saltspring Antique and Classic car Club - Registration 2011

C/O 111 Graham Dr.

Saltspring Island B.C. V8K 1J5

Please mail before June 20th 2011.

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Saltspring Antique and Classic car Club

Registration

Canada Day Show and Shine 2011

Name____________________________________________

Address___________________________________________

City_____________________________ Prov/State _______ Postal Code _____________

Phone number (___) ____ _______ email ____________________

Make of Car ____________________ Model ________ Year_________

Custom____ Stock______

Make of Car ____________________ Model ________ Year_________

Custom____ Stock______

Entry fee enclosed $15_____ or $_______Cdn Check___ M/O

Signature _________________________________ for office use # _____

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