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NAME:_______________________________________________ PHONE:_______________________________________
ADDRESS:____________________________________________________________________________________________
CITY:____________________________________ STATE:_____________ ZIP CODE:___________________
VEHICLE INFORMATION:
YEAR:_______________ MAKE:__________________________________ MODEL:_____________________________
COLOR:___________________________________ CLASS:_____________________________________
ADVANCED REGISTRATION= $12.00 REGISTRATION AT GATE $15.00***First 100 participants receive a gift bag which includes a 19th Annual Dash Plaque*** Please mail checks no later than August 15, 2010 ~ payable to North Country Chamber of Commerce
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