Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeVehicle DetailsYearMakeModelDescriptionCar Club Affiliate (if any):Email *Select Shirt Size *SmallMediumLargeX-LargeXX-LargeXXX-LargeEntry Price *Price: $ 25.00Square *CardName on CardSingle Checkbox Field *I agree.I will not hold the Ephrata Chamber of Commerce and/or the City of Ephrata responsible for any damages which may occur to me and/or my property as a result of my participation in any of the Ephrata Chamber of Commerce Anything with Wheels activities/events. Decisions of the prize judges for all classes, contests, and events will be final and left undisputed. Submit