Class
B Entry Form
1/ Your Personal
Information
First Name:
Last Name:
Address:
City:
State or Country:
Postal Code:
E-mail Address:
Website:
2/
car(s) you wish to enter
Car
Name: Model
year:
Chassis:
Motor:
Please
provide any additional comments, details or information
below
3/
submit you entry fee/donation to the Marconi Foundation for
Kids
First
car fee: $25.00. Additional cars: $20.00 each. Add $6.95 for
return postage in the USA. Inquire for return postage to
other countries. Larger tax-deductible donations are
welcome, search your wallet and your heart.
Payment
form: Credit Card (
or
only): or 
:
For PayPal, use info@electric-dreams.com
Card
Number: Type with no space between numbers.
Exp.
Date: Month (00) Year
(00)
S&H
Return Charges will be charged to your credit card at cost.
Push
"Send" button below. You may get several messages
depending on your browser. Please ignore the contents of the
messages, as the information submitted IS
encrypted, and push "send" or
"OK" after each
message. The form will still appear after the last message
received and the message is actually sent.