2012 Medford Cruise Online Registration Form Just fill out this one form, and all of your event registration and merchandise requests will be handled securely in a single transaction via Pay Pal. You may also register by downloading our new printable form, filling it out and mailing to: Medford Cruise, PO Box 629, Medford OR 97501 Entrant Information (required fields) First Name Last  Name Mailing Address City State, Zip AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY MS LA ME MD MA MI MN MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY   Email Phone Car Club Returning Entrant?Yes No Address Change?Yes No Contact me about vendor booth space Insurance Information (all fields required) Your Insurance Provider Your Policy Number Policy Effective Date Event Registration (required fields) Medford Cruise includes T-Shirt, Dash Plaque, Sat. & Sun. Show n' Shine, Concert and Cruise and 1 Poker Run Hand       Requirements: Vehicle must be 1972 or older Register for Medford Cruise June 16 - Entry Fee: $50 per car  Select Shirt Size S M L XL XXL XXXL I will also be showing at the Unlimited Show 'N Shine June 17 (Free with Medford Cruise Registration) Register for Unlimited Show 'N Shine June 17 Only - Entry Fee: $10       NOTE:  Unlimited Show 'N Shine is FREE with Medford Cruise Registration - any make / model plus motorcycles Car 1 Car 2 Make: Make: Model: Year: Model: Year: Car 3 Car 4 Make: Make: Model: Year: Model: Year: Register for Drift Evolution June 12-13 - Entry Fee: $75 (Please fill out required information below) Is this car registered for highway operation? Yes No LSD Yes  No Engine Spec: Turbo / Aspiration: Suspension: Sponsor Information: Team: Special Modifications: Driver history, milestones and championships for individual, team and sponsors / length of competitive drift / racing experience: How did you hear of this event? Additional Event Tickets and Merchandise Drift Evolution Spectator Tickets June 9-10 | $5 each | Enter qty: Poker Run June 15 | $5.00 per hand (First hand free with Cruise Registration) | Enter additional hands: Participate in June 15 Drag Races  | $25.00 per car | Enter number of cars:      Vehicle must be 1972 or older - mandatory safety inspection and approved crash helmet also required Spectator Ticket(s) to Drags June 15 | $10.00 each | Enter qty: I would like to ride in a Shelby Cobra - Time Trials June 15       Rides $20.00 each | Limit 2 rides (1 rider - 2 rides or 2 riders 1 ride each)  | 1 Ride  2 Rides I would like Pancake & Egg Breakfast Tickets | $6.00 each | Saturday qty:     Sunday qty: I would like to purchase additional Medford Cruise T-Shirt | T-Shirts $20.00 each Small | Enter qty:     Medium | Enter qty:     Large | Enter qty:        X Large | Enter qty:      XX Large | Enter qty:       XXX Large | Enter qty:  I want to purchase additional 3-Pack of Vintage Cruise T-Shirts | $20.00 each - quantities limited Small | Enter qty:      Large | Enter qty:      X Large | Enter qty:    I would like to sponsor a trophy | $50.00 each | Enter qty:  I would like to donate to Medford Cruise | Donation Amount: $20   $30   $50   $100 Submit Form Your Registration Total: