MW Registration

4th Annual PT CRUISER Midwest Regional Registration Form.

Registration Fee as of 08/28/03 $45 (Free Event T-Shirt ONLY if Pre-Registered by
August 10th 2003.) Fee is per Car. This years event is being held in Winfield, KS
ONLY!

Print and Fill out form completely. Please, let us know how many BBQ Passes you will
be needing. Limited Quantities of T-Shirts for sale available day of the Event.

Send to Richard Zimmerman, 3818 Wesley Drive, Wichita, Kansas 67227

Check are to be made out to: Wichita Area PT Cruiser Club.

Name:_____________________________________________________________

Address:_________________________________ City:______________________

State:____________ ZIP:_________ Phone:_______________________________

EMail Address:______________________________________________________

Year:__________ Make:________________ Model:_________________________

Color:___________________ BBQ Passes:_____________

ONE FREE EVENT SHIRT - SIZE_____________________

EVENT SHIRTS ( S-XL $15.00 - XXL - XXXL $17.00)____________________________

Registration Fee as of 08/28/03 $45 ___________________

Post marked after 08/28/03 $50_______________________

Total____________________

*Event management, Sponsors, City of Winfeild, PTCC and the Winfeild Motor Company (by
execution of this form) are released and discharged of liabilities known and unknown, injuries,
losses, judgements and/or claims resulting from the conduct of participants and spectators.

*SIGN________________________________________________________________________

Hotel Information:

Super 8 (Host Hotel)

(620) 229-8888

3803 Pike Road, Winfield, KS 67156

Comfort Inn at Quail Ridge

(620) 221-7529

HWY 77 at Quail Ridge Drive, Winfield, KS
67156

Best Value Camelot Inn

(620) 221-9050

1710 Main Winfield, KS 67156

Sonner Motor Inn

1 (620) 221-4400

1812 Main St.

Winfield KS 67156

The Hotels WILL NOT block off rooms this year.
I guess filling the hotels the last 3 years was not
good enough. You are all on your own this year.
SORRY!