If you have a "very nice" old original 426 HEMI MOPAR and would like to participate in an Special INVITATIONAL "MOPAR SURVIVOR" display at the All HEMI Reunion August 22-24, 2008 held at Quaker City Raceway, Salem, Ohio , complete this form and return it by May 1^st.

General Criteria: original 426 HEMI, "unrestored original". This requires 80% of the paint to be the factory applied, 80% of the interior to be the factory installed, and 80% of the drivetrain to be the factory installed. This will be a non-judged "display only".

Name___________________________________________________________________

Address_________________________________________________________________

City / State / Zip __________________________________________________________

Phone / E Mail___________________/____________________________________

Vehicle year____________ Make / Model______________________________________

Engine______ Trans________ Mileage___________ Owner (1^st, 2^nd, etc)___________

Color-Exterior______________________ Interior__________________

814-734-1565, mkmajor@surferie.net