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9th Annual Midwest Willys Jeep Reunion & Swap Meet Preregistration Form
2003 Midwest Willys Jeep Reunion & Swap Meet Preregistration Form
October 4th - 5th, 2003 ~ Jefferson City, MO
Midwest Willys Jeep Reunion
c/o Tom R. Johnson
7078 Crisptown Road
Mountain Grove, MO 65711-3045          

  PHONE: (417) 668-5555

YOUR NAME________________________________________ DATE_______________________________________
ADDRESS__________________________________________ ZIP CODE:___________________________________
CITY/STATE_________________________________________ PHONE #____________________________________
E-MAIL ADDRESS____________________________________
Please include your telephone number and email address.

Is this your first time attending the reunion?  YES NO

Willys Vehicle Registration
[ For Willys vehicles you are bringing to the Reunion ]

Willys Vehicle _______________________Year______________Model_______________________
Willys Vehicle _______________________Year______________Model_______________________
Willys Vehicle _______________________Year______________Model_______________________

Preregistration: $8.00 per vehicle.      Number of Vehicles___________   Total Fee $____________

Saturday Banquet Registration

[ Note: NO Banquet tickets will be available at the Reunion. ]

Adults ________ @ $17.50 per ticket ( includes tax and gratuity )   Total $____________

Children ________ @ $8.75 per ticket ( 12 years and under )       Total $____________

TOTAL DUE for Vehicle Registration and Banquet Tickets **   Total $____________
** NOT Refundable after September 10th deadline.


Please note: Midwest Willys Jeep Reunion is not responsible for lost, damaged, or stolen items.

Please make check or money order PAYABLE TO: Midwest Willys Jeep Reunion