2017 Eastern Grand National Meet 
2017 Bricklin Eastern Grand National Meet
Dover DE July 12th 16th, 2017
Name: __________________________________________________ Name to appear on badge:
Street Address: ___________________________________________ 1) __________________
City: __________________ State: ____________ Zip: __________ 2) __________________
Bricklin VIN: _________________________ Car Color: ___________ 3) __________________
Email: ______________________________________ (optional) 4) _________________
TOTALS
Meet Registration $40.00
After 5/31/2017 $50.00

Saturday Banquet $40.00 x how many (____)
Main Course
(choose one per person attending) Stuffed Pork Chops (____)
Chicken Cordon Bleu (____)
Bric-Nic $10.00 x how many (____)
Dover Downs Track & Tour Car & Driver $20.00
Passenger $10.00
TOTAL ENCLOSED

Make Checks payable to BRICKLIN INTERNATIONAL
SEND TO:
Rose Stayton PO Box 485 Frederica DE 19946-0485
Meet Directors:
Mark and Rose Stayton markandrose2@msn.com
Mark cell: 302-423-0024
Rose cell: 302-670-2035

Hotel:
$99.00 per night, includes continental breakfast
Mainstay Suites
201 Stover Blvd
Dover DE 19901
(302) 678-8383
Call for reservations mention Bricklin Car Club

Birthdays: