Tupelo Cruise 2012
Registration Form

Personal Information
Fields marked with an * are required.
First Name: *
Last Name: *
Address: *
       
City: *
State: * Zip Code: *
       
Email Address: *
       
Primary Phone: *
Alternate Phone:
Cell Phone:
       
Club Affiliation:
       
Hotel Information
This information is only for information purposes.
You must make your reservations with each hotel separately.
Hilton Garden Inn ($139/night plus tax)
Group Name
"MUSTANG EVENT"
Rodeway Inn ($69/night plus tax)
 
Clarion Inn ($84/night plus tax)
 
Other
 
None
 
     
Guests Attending
First Name:
Last Name:
First Name:
Last Name:
First Name:
Last Name:
       
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 (MM/YY)
   
Show and Shine Vehicle Information
 
Vehicle 1 Information: SHOW AND SHINE IS FREE!
 
Year Coupe / Vert:
Make Model
Ext Color:
Stock Concourse   Modified
   
Vehicle 2 Information: If you are bringing two vehicles
 
Year Coupe / Vert:
Make Model
Ext Color:
Stock Concourse   Modified
 
Vehicle 3 Information: If you are bringing three vehicles
 
Year Coupe / Vert:
Make Model
Ext Color:
Stock Concourse   Modified
 
Vehicle 4 Information: If you are bringing four vehicles
 
Year Coupe / Vert:
Make Model
Ext Color:
Stock Concourse   Modified
 
Banquet/Breakfast Registration
 
Please enter the number of tickets you need below.
 
Food Tickets   $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).