Name________________________________

Address______________________________

City_________________________________

State________________________________

Zip Code____________________________

Phone #____________________________
Pre-Registration
for 2009 Show
Year & Make of Car_____________________________

Club Affiliations_______________________________

Comments____________________________________

______________________________________________

______________________________________________

Shirt size- S M L XL 2X 3X (circle one)
Please print & Mail along with a $15 check
payable to "Igniters Street Rods" to:
Igniters Street Rods
81 Lakeview Drive
Chillicothe, Ohio 45601
E-Mail Address _______________________