Copy and Paste Pre-Registration Form Shine a Light on Lung Cancer Open Car & Motorcycle Show Friday, November 2 5:30 - 8:30 p.m. 1203 S. Tyler Street, Covington.LA Parking Lot of St. Tammany Cancer Center Pre-Registration Form | Rain or shine no refunds Donation entry fee must be postmarked before Oct. 19 Minimum donation entry fee $25 After Oct. 19 | Minimum donation entry fee $30 Please mail your completed registration form to: St. Tammany Cancer Center, Attn: Lori Chopin, 1203 S. Tyler Street, Covington, La 70433 Make checks payable to: Lung Cancer Alliance Check Amount: ___________ Name: _______________________________________ Address: _____________________________________ City: ________________ State: ____ Zip: ________ Phone: ___________________ Email: ________________________________________ Vehicle Info: Year: ______ Color: _________ Body Style: _______ Club Affiliations: ____________________________ Circle one: Stock Modified Owner’s Signature: _____________________________ Date: ________________ If you have any questions, please email Lori Chopin at Lchopin@stph.org