Blue Suede Cruise Registration

Print, complete and Mail this page & $35 check to:
Blue Suede Cruise, P.O. Box 746, Tupelo, MS 38802

Name:_____________________________________

Email:_____________________________________

Country:___________________________________

Address:___________________________________

City:______________________________________

State/Zip:__________________________________

Days Attending:______________________________

Car Year:___________________________________

Car Make:__________________________________

Car Model:__________________________________

Insurance Provider/Coverage:____________________

Phone:_____________________________________

Guest Attendee (name of guest traveling with you):
__________________________________________

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