June 10th, 2007/ Rain Date June 17th,2007
Name:________________________________________________
Address:_______________________________________________
City_________________ State _______________ Zip___________
Phone Number _____________E-mail Address_________________
Year/Make/Model of Automobile_____________________________
Motor Size_____________ Name of Owner____________________
Shirt Size: (circle one) Lg Xlg XXlg
Entry Fee: Pre-Registration cars $10.00 Day of show $12.00
Registration Fee Includes:
Entry to the event
Two door prize tickets
One tee shirt for the first 100
One Dash Plaque for the first 100
All proceeds for this event are to benefit the American Diabetes Association;
it's sole purpose is to raise money to fund research to find a cure for diabetes.
On behalf of the American Diabetes Association, we would like to thank you for
your participation.
Signature_____________________________Date_____________
*Mail Pre-registrations to :
Cruzin for a Cure
c/o The Marion Family
328 Irma Dr
Chardon, Ohio 44024
Please make Checks Payable to : The American Diabetes Association