I am registering for:
Cannonball One Lap Driving School on
Sat., April 5 and Sun. April 6 (Includes Dinner) -
$365
Cannonball One Lap Driving School on Sat., April 5th (without
Dinner) - $205
Cannonball One Lap Driving School on Sat., April 5th (with
Dinner) - $230
Cannonball One Lap Driving School on Sun., April 6th (without
Dinner on Sat. evening) - $180
Cannonball One Lap Driving School on Sun., April 6th (with
Dinner on Sat. evening) - $205
Dinner Only on Sat. Evening, April 5th -
$38/person
Dinner Only for a Table of 8 people on Sat. Evening, April
5th
- $285
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First Name |
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Last Name |
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Middle Initial
(Optional) |
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Title (Mr.,
Ms. Mrs., Dr.) |
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Street Address |
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Street
Address (cont.) |
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City |
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State
Abbreviation |
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Zip/Postal Code
(5-digit is OK) |
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Country |
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Email Address |
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Daytime Phone #
(Area Code-nnn-nnnn) |
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Car
(Make Model Year Color) |
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Will be sharing above car with (First
& Last Name - Leave Blank if Not Sharing) |
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Blood Type
(for example, A+) |
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Allergies
(if none or unknown, enter NKA) |
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Emergency Contact Name (First & Last) |
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Emergency Contact Phone # (Area Code-nnn-nnnn) |
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# of Road Course Track Days at BeaveRun |
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# of Road
Course Track Days Elsewhere |
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If you hold an active competition
license, name of Sanctioning Body |
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If you've run the
Cannonball One Lap event before, number of times |
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Will you be entering the
Cannonball One Lap Event for 2008? |
Yes
No |
If paying via Credit
Card/PayPal, Account Name that will be used |
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Click the Submit Form
button only once after all required information is
correctly entered... you will get a confirmation message but be
patient and don't click more than once.
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