Darryl Starbird's

National Rod & Custom Car 
Hall of Fame Museum


PRINT THIS FORM and Fill it out COMPLETELY to be sure that your entry is processed correctly!

THANK YOU.


Wall of Fame Submission Form:

Name: _______________________________________________________

Address/City/State/Zip
: __________________________________________

Year/Make/Model: ____________________________________________________

Builders Name: _______________________________________________________

Date Built: ___________________________________________________________

(Be sure to include a good 8X10 or negative of the vehicle you are submitting to the Board).
 

SIGNED _____________________________________________________________ DATE __________________
                                                    (Owners Signature)


Mailing Address:

National Rod & Custom Car Hall of Fame Museum

55251 E. Hiway 85A
Afton, Oklahoma 74331

 


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