Pre-Registration for

The First Annual Diverse Concepts Car Show

In order to register you must fill in all info before submitting.

Failure to do so will result in your car or truck not being registered.

Once you have submitted the form please come back to form and click on the Paypal button to pay for registration. Failure to pay will result in not being registered.

If you have any questions please contact Jason Kilpatrick via email

Pre-Registration Cost: $15.00
At Show Registration: $20.00

Payment for show is non-refundable

Name:

Address:

City:

State:

Zip Code:

Email Address:

Car Make:

Car Model:

Car Year:

Car Club:

Mods:

PLEASE REMEMBER TO COME BACK AND CLICK ON THE PAYPAL BUTTON TO PAY FOR YOUR REGISTRATION. FAILURE TO DO SO WILL RESULT IN YOU NOT BEING REGISTERED.