Middle Peninsula Mopar Association Sponsorship Registration Form
BUSINESS INFO: Business Name: __________________________________ Business Phone: _______________________________
Business Email: __________________________________ Website: ______________________________________
Address: _____________________________________________________________________________________
City: __________________________________________ State: ________________ Zip: ______________________
What is your main Business and/or Service: ___________________________________________________________
CONTACT INFO: Owners Name: _________________________________________________________________________________
Contact Name: ______________________________________ Contact Phone _______________________________
Contact Email: ______________________________________ Contact 2nd Phone #: __________________________
What Level of Sponsorship Are You Signing Up For?
Please supply us with you logo by email (.jpg or .gif format) tkeefer@cox.net or mail logo that can be scanned to the address below. Check here if you do not have a logo.
Date: _____________________________________________ Print Name: ______________________________________________
Signature: __________________________________________________________________________________________________
PAYMENT METHOD:
Check #___________ Money Order Cash Amount: _________________________ (sorry we do not accept credit/debit cards)
Print and Mail this form & Payment to:
Middle Peninsula Mopar Association PO Box 1734 Hayes, VA 23072
For more information, contact Tim Keefer 804-684-5332. Visit our website for show information www.moparassociation.org
Please respond AS SOON AS POSSIBLE to take full advantage of the promotional opportunities.