Tupelo Cruise Registration Form

Personal Information
Fields marked with an * are required.
Name: *
Address: *
City: *
State: *		Zip Code: *
Email Address: *
Primary Phone: *
Alternate Phone:
Cell Phone:
How did you hear about the Tupelo Cruise?
Internet Car Show Event Flyer Other
Other (describe)
Would you like to receive email updates for this event? NO YES
If you are a Mustang Club of America member please enter your MCA #
MCA Expiration Date
Show and Shine Vehicle Information
Vehicle 1 Information: SHOW AND SHINE IS FREE!
Year		Coupe / Vert:		Coupe Convertible
Make		Model
Ext Color:
Stock	Concourse		Modified
Vehicle 2 Information: If you are bringing two vehicles
Year		Coupe / Vert:		Coupe Convertible
Make		Model
Ext Color:
Stock	Concourse		Modified
Vehicle 3 Information: If you are bringing three vehicles
Year		Coupe / Vert:		Coupe Convertible
Make		Model
Ext Color:
Stock	Concourse		Modified
Vehicle 4 Information: If you are bringing four vehicles
Year		Coupe / Vert:		Coupe Convertible
Make		Model
Ext Color:
Stock	Concourse		Modified
Banquet Registration
Please enter the number of banquet tickets you need below.
Banquet Tickets	0 1 2 3 4 5 6 7 8 9 10   $30 for each ticket.
Method of Payment
Select the method of payment below.
PayPal Acct Credit Card   Check via US Mail
Once you have completed the form press Submit. You will receive an email confirming your registration request and instructions for payment via PayPal (if applicable).