Sport Classic & Competition Track Day
At Carolina Motorsports Park in Kershaw, South Carolina
Friday Sept. 18th 2009 Event Registration Form
Mail to: PO Box 11, Mt. Mourne Nc. 28123 attn: Wade R. Nunez
$300.00 per car / $25.00 per additional Driver / $15.00 for guests (includes lunch)
Please register as early as you can we will need to limit the event.
Name:________________________________________________________________________
Street:________________________________________________________________________
City:________________________State:__________________________ZIP:_______________
Phone: (Day)____________________(Night):____________________(Cell):_______________
Please read and sign: I hereby certify that I have no known physical or medical problems that might jeopardize others or myself if I participate in this event. ___________________________________
Driver and Car Information
Make ___________________________ Model___________________________________
Color____________________________Chassis #_________________________________
Driver: If same as above leave blank.
Name_________________________________________ DOB_______________________
Additional Driver:
Name__________________________________________DOB_______________________
Please read and sign: I hereby certify that I have no known physical or medical problems that might jeopardize others or myself if I participate in this event. __________________________________
Total Amount Paid $___________________________ Check #____________________________
Please make checks payable to Sport Classic & Competition
Print this form and send registration form to above mailing address or fax to 704-943-0687
To pay by Credit Card go to Paypal.com and send to sales@sportclassiccomp.com
Credit Card payments require an additional 4% service fee.
Gates open at 7am / Mandatory drivers meeting at 8am / Track time 8:30am – 5:30pm