2008 REGISTRATION FORM

PLEASE  FILL  IN  1  FORM  PER  VEHICLE

Owner's Name:      

                             First Name                                     Last Name

Address:  

                          

                        City

 

                      

           Prov            Postal Code

 

Home Phone:     Business Phone:  

Fax Number:           Email Address: 

VEHICLE SPECIFICATIONS

Year:    Make  (eg. Chevrolet, Ford, Hudson): 

Model (eg. Impala, Mustang, T): 

Body style (eg. Sedan, coupe, convertible, truck): 

Manufacturer:

MECHANICAL SPECIFICATIONS

Engine Configuration (eg. V-8, straight 6, flathead): 

Horsepower:    Displacement (cu. in. or c.c.): 

Original Cost (US or CDN): $  

Unique features and/or facts about this specific vehicle (list in point form please):

 

I will display my vehicle on (check one):  Saturday, June 14, 2008

                                                             Sunday June 15, 2008     

                                                               Both days

I will display my vehicle in (check one):   Chronological display

                                                             Motorcycle display

                                                             Hot Rod & Custom display

 

Collection of the personal information on this form is authorized under Section 6 of the Alberta Historical Resources Act and is required for the purpose of staging the Reynolds-Alberta Museum History Road Special Event.  The information will be used to maintain a contact list of participants and is subject to the disclosure rules set forth in the Freedom of Information and Protection of Privacy Act.  For further information about the collection and use of this personal information, please contact Jim Takanaka at (780) 361-1351.

Reynolds-Alberta Museum

Box 6360

Wetaskiwin, AB  T9A 2G1

  

Fax: (780) 361-1239

Email: jim.takanaka@gov.ab.ca

Phone: (780) 361-1351

Toll-free: 1-800-661-4726