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TRACK DAY REGISTRATION FORM 2010 02/11/11
(Click here for a printable format)
*** Be sure to look at the required technical inspection form
1. REGISTRATION: SEND CHECK OR MONEY ORDER or PayPal (See bottom of page)
PAYABLE TO C.A.R.T.
2. MAIL TO: JAY BODE, 32 COREY RD., NORTH HAVEN, CT 06473
3. SELECT EVENT DATE:
___ Lime Rock Park $365.00 ___ June 23, 2011 FULL DAY EVENT includes surcharge
___ Pocono North Course $225.00 ___ August 27, 2011 INCLUDES TEAM RELAY
___ Lime Rock Park $315.00 ___ September 22, 2011 FULL DAY EVENT
NOTICE!!! There is a $50 surcharge if you have not signed up for an event 2 weeks prior to the event.
IF YOU ARE INTERESTED IN MEMBERSHIP IN CART-CHECK HERE_____
NAME: _____________________________ AGE ____
ADDRESS:___________________ CITY:______________
STATE:_________ ZIP:_________ PHONE:____________
E-MAIL:_______________________________________
SHIRT SIZE L____ XL_____ XXL____
CAR:MAKE:___________________ MODEL:_________ YEAR:________
COLOR:______________SCCA AUTOCROSS SOLO 2 (IF KNOWN) :_____________
ENG.DISP:____________ CAR:STREET/RACE_______
TURBO/SUPERCHARGED_______INTERCOOLED:_______ FACTORY:Y/N________.
TIRES:RACE (NON DOT):Y/N_______ TREAD WEAR RATING_______
AREA MODIFIED:ENGINE:Y/N_______ SUSPENSION:Y/N_______
BODY/INTERIOR MODIFICATIONS:____________________________
TRACK EXPERIENCE LEVEL NONE____ SOME___ CONSIDERABLE_____
IF YOU INDICATED SOME OR CONSIDERABLE TRACK EXPERIENCE, PLEASE LIST EXPERIENCE
____________________________________________________________
HOW DID YOU FIND OUT ABOUT CART (MAGAZINE, ON LINE ETC)
____________________________________________________________
LIST ALL MODIFICATIONS ON BACK OF FORM ____________________________________
NO REFUNDS WITHIN TWO WEEKS OF THE EVENT
WE LIMIT THE EVENTS TO 50 CARS AT POCONO - FIRST COME FIRST SERVE BASIS
WILL YOU BE RUNNING IN THE TIMED PORTION OF THE EVENT? Y/N_____
ARE YOU INTERESTED IN RUNNING THE TEAM RELAY (POCONO ONLY) Y/N_____
OFFICIAL USE ONLY:
CAR NUMBER:______CLASS______PRACTICE GROUP_______FEE_____
Now pay online with your credit card. Please note there will
an additional charge for processing a credit card from Paypal.
Paypal's fee is the original amount times 2.9% + $0.30 USD.
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