|
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
������������������������� |
|
First Name |
|
|
Last Name |
|
|
Middle Initial
(Optional) |
|
|
Title�(Mr.,
Ms. Mrs., Dr.) |
|
|
Street Address |
|
|
Street
Address (cont.) |
|
|
City |
|
|
State
Abbreviation |
|
|
Zip/Postal Code
(5-digit is OK) |
|
|
Country |
|
| Email Address |
|
|
Daytime Phone #�
(Area Code-nnn-nnnn) |
|
| Car
(Make Model Year Color) |
|
|
Will be sharing above car with (First
& Last Name - Leave Blank if Not Sharing) |
|
| Blood Type
(for example, A+) |
|
| Allergies
(if none or unknown, enter NKA) |
|
|
Emergency Contact Name (First & Last) |
|
|
Emergency Contact Phone # (Area Code-nnn-nnnn) |
|
|
# of Road Course Track Days at BeaveRun |
|
|
#� of Road
Course Track Days Elsewhere |
|
|
If you hold an active competition
license, name of Sanctioning Body |
|
|
If you've run the
Cannonball One Lap event before, number of times |
� |
|
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 |
|
| � |
� |
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.
����
|
| � |
� |
