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Your full name:
Your email address: (e.g.: you@aol.com)

Your phone number (with country, city, area codes):

Address:
City/Town: State/Prov.: Post./Zip Code:
Country:

How did you hear about the registry?
Describe briefly how/where you acquired the vehicle; or add any other details you'd like to share with other owners.
Choose which vehicle you have:   67 Ambassador DPL convertible   68 Rebel convertible   68 Rebel SST convertible
List any options your car has:   AT-Flashomatic   AT-Shift-Command   AC
Choose ORIGINAL engine size
Are you using antique or special license plates on this vehicle?

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