Office use

#_____
Giving Roxanne a Voice

Car, Truck & Bike Show

Registration Form
$20.00 if preregister by September 15, 2015
$30.00 if register after September 15, 2015
Dash Plaques to the first 50 entries
Send Registration Form and check made payable to the Roxanne Poulos Foundation
To
PO Box 148
Hope Mills NC 28348
PERSONAL INFORMATION
NAME:_________________________
DATE:________________________
ADDRESS:_________________________
CITY:_________________________
STATE:_________________________
PHONE:__________________
VEHICLE INFORMATION
YEAR:____________________
MODEL:___________________

MAKE:____________________

STOCK: An automobile that has not been modified from its original factory configuration. Anything available on
the exact year and model of the vehicle as standard or optional equipment, as installed on the factory assembly line,
as well as standard OEM identical replacement parts are acceptable.
MODIFIED: Any vehicle that has been changed from its original manufactured or "stock" condition. This includes
changes in engine or drive train which were not available in the original manufactured year, increase in horsepower,
or custom paint and/or decals. Generally, safety-related modifications such as steering, brakes or tires and wheels are
not considered modifications.
By the above definition is the vehicle (Circle 1)
Competition class entered

Pre 1950
1950s
1960s
1970s
1980s
1990s
2000 to Present

STOCK

MODIFIED

_________________________
Classes
Rat Rod
Rat Bike
Vintage Motorcycle (pre 1985)
Motorcycle (1985 to present

Pre 1950 Truck

1950 to 1970 Truck
1970 to 1990 Truck
1990 to present truck

There will be 2 Best in Class trophies awarded in each class except for Rat Rod and Rat Bike, 1
best stock entry in each class and 1 best modified entry in each class. Rat Rod and Rat Bike will
have 1 trophy per class
The vehicle with the top score will receive Best in Show. All other vehicles then compete in the
class in which they have entered.