2006 MOFLO Registration

Please print out and send with your entry fees to the address below Before May 15.

Names of Adults:

1.

2.

3.

For Your ID Badge:

Please attach a photo of your car that you would like to use on your name tag to an email address to kdickson@kendickson.com To get your dash-plaque and nametag, you must register before May 15.

Names of Children: No registration fees for children under 12.

Children under 12 will receive free ID tags if registered before deadline.

Street Address:

City: State: Zip: E-mail address:

Vehicle Information:

Make: _______________________

Model: ______________________

Year of Car: __________________

Arriving Friday? (circle one) YES NO

Saturday Dinner: $25 per adult. This will be paid to the restaurant

Do not send payment with your Registration.

Please note the total number of each dinner for your party.

________8 oz Prime Rib of Beef,

________Salmon Grilled

________Chicken Marsala.

Dinner will include a salad with Ranch dressing, baked potato with butter and sour cream, rolls and butter, coffee or tea, and Dutch Apple Cake for dessert. The price is $25 per person which includes tax and gratuity. Liquor, wine, beer are optional extras

Mail Your Event Registration to:

Michael R Greer

2308 Chapel Hill Ct

Bartlesville, OK 74006-7514

__________________________________________________

T-Shirt order form:
T-Shirts must be ordered before April 30th. You must send in your shirt order separately. Remember T-Shirt Deadline April 30

T-Shirts: White or Grey with MOFLO graphic $15 each.

Available in Adult S through XL - XXL and XXXL available but $3.00 more.

You may pay for your T-Shirt by PayPal. Send your total to kdickson@mirafiori.com if you like

Please indicate number and size

Number ________ Sizes/Colors

Mail t-Shirt order to:

Ken Dickson

9530 N. St. Route 94

West Alton, MO 63386