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Online Registration

Online Registration Form

June 10th, 11th, 12th & 13th '2010'


All Items in red with a  * must be filled in or the form will not submit. 
After filling out all of the required spaces press the submit button at the bottom of the page. A response message will return to your e-mail. If you have spam blocker truned on you may need to check your spam folder for the response.

His & Her First Name *
Last Name *
Email *
Address *
City *
State *
Zip *
I am new to Peggy Sue's Cruise? *  Yes
  No
Phone *
Year *
Make *
Model *
Engine Cublic Inch *
License Plate Number *
State *
Would you like your car judged? *  Yes
  No
Please select one class. *
FREE T-Shirt included in entry fee n/c. *
Men's T-Shirts for sale $18.00 each
Lady's T-Shirts for sale $18.00 each
Number of shirts being purchased
Poker Run $5.00 per hand  Yes
  No
Per hand, Amount Due $
Total Amount Due for shirts $
Registration Fee $ *
Total Amount Due $ *
Credit Card *  Visa
  MasterCard
Credit Card # *
Exp. Date (mm/yy) *
I have read and accept the Rules & Regulations *  Yes

* indicates a required field


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©2004 Peggy Sue's Cruise
1935 Amy Ave Santa Rosa, CA 95401
phone: (707) 575-3267 | fax: (707) 575-3477 | email: info@peggysuescruise.com