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Preregistration Form


Schedule of Events
Saturday, July 17, 2004
7:30-9:00 Autocross Registration
9:00-9:30 Course Orientation
9:30-3:00 Autocross Heats
3:00-4:00 Autocross Awards
6:00-???? Picnic
Sunday, July 18, 2004
8:00-12:00 Show Car Registration
12:30 - 2:00 Voting
12:30 - 4:00 *Door Prizes
4:00 - Trophies Awarded
* Door prize winners will be announced and posted throughout the afternoon.

Please print this form and mail with check or money order by July 3rd to:
"Fords at the Mall"
c/o Rod Dieffenbacher
315 Klump Road
Cogan Station, PA 17728

Autocross (Saturday) - $15/car

Picnic (Saturday) - $5/person

Car Show (Sunday) - $8/car
(Day of show registration will be $10.00)

T-shirts: $10/each
($12/each day of show)
Med. - Lrg. - X-Lrg. - XX-Lrg.

x ____ = _______

x ____ = _______

x _____ = ______

x _____ = ______


Total Enclosed:

________________


Name:____________________________________

Address:__________________________________

City:_____________________________________

State:_______________ Zip:__________________

Phone:____________________________________

Car Model:___________________ Year:_________


For additional information please contact: 
FATM Show Committee

or call:
Tom Shreiner: 570-916-1999 or
Rod Dieffenbacher: 570-435-0807