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   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 
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: