Full Name:_________________________ Spouse or 2nd Person:   ______________________________

Children (12 and under) _________________________________________________________________

Home Address_________________________________________City:________________________

State and Zip:______________________ Phone#:    ________________________________________

 E Mail:  ____________________________   Cell Phone#  _____________________________________
 
Car Model:_______________________________ Year   ___________   Color:__________________

License #____________________________
 

Registration  Fee Schedule                                                                                    Cost          Qty                Total

Basic (first person)  Registration                                                                               @   $45   x      1               $45
Full Registration with car  Includes Hospitality, poster etc.

Registration for Spouse or 2nd person   (Same car)                                                 @  $15   x   _____          ______

Saturday Brats & Burgers grill out lunch                                                                   @   $12   x   _____         ______

Saturday Silent Auction & ACD Tour and Banquet  (per person)                              @   $47   x   _____         ______
(Includes admission to entire ACD museum showrooms, open bar and banquet)

check your entrée choice(s): glazed salmon ____  roast pork ____  bruschetta chicken  ____
 

Late Registration:  Postmarked after August 22, add:                                              $30    x      1      _____

TOTAL ENCLOSED                                                                                                                                          $______
 

Make Check for Registration Payable To:  OH MOG
Mail to: MOG MIDWEST c/o Gary Kneisley
39048 Robson Rd.
Grafton, OH 44044
Inquiries to OhMog@oh.rr.com  or Gary Kneisley 440-458-5955.

Please remember to bring something to donate for the silent auction.

Make your own Lodging Reservations at Auburn Inn. (waiting list now at Auburn Inn, use one of our backup hotels – see flyer)  Make your room reservation with (waiting list) Auburn Inn 260-925-6363 (Meet hotel) or backup hotels: Holiday Inn Express 260 925-1900  La Quinta Inn 260 920-1900 (both are short walking distance from the Auburn Inn)

The undersigned desiring to enter and participate in the MOG MIDWEST MEET 2009 does hereby tender his/her application. In consideration of acceptance by OhMog of this application, the undersigned does hereby: 1) release, indemnify and hold harmless OhMOG, and its agents against any and all claims for loss, injury or damages to person or property arising out of said event. 2) Give permission to use any information, photographs, or video information obtained prior to and at event for publication, promotion, advertising or video filming. 3) Attest that I (we) have current automobile liability insurance and valid drivers license.   The event is rain or shine.
 
 

X_________________________________________________________________Date:_____________________________________
  (vehicle owner) have read the above and accept the terms and conditions.