March 18-19, 2000
Driver 1
Name ________________________________________________________________________
Phone (Home) (____)________________________
(Work) (____)________________________
Email Address__________________________________________________________________
Home Address__________________________________________________________________
_____________________________________________________________________________
Driver's License # (req'd)_______________________________ State_________
Total number of previous track events____________
Where_______________________________________________________________________
Number at Summit Point____________
Rate your track driving skill level (circle one):
Novice (no events)
Beginner (1-2 events)
Intermediate
Advanced
Any other information related to your driving skill: _____________________________
______________________________________________________________________________
Car you will be driving: Year___________ Make___________________________________
Model__________________________________ Color__________________________________
Insurance Carrier (required)____________________________________________________
Policy #______________________________________________________________________
Car Number preferred (1st come, 1st served)_______________
Driver 2
Name ________________________________________________________________________
Phone (Home) (____)________________________
(Work) (____)________________________
Email Address__________________________________________________________________
Home Address__________________________________________________________________
_____________________________________________________________________________
Driver's License # (req'd)_______________________________ State_________
Total number of previous track events____________
Where_______________________________________________________________________
Number at Summit Point____________
Rate your track driving skill level (circle one):
Novice (no events)
Beginner (1-2 events)
Intermediate
Advanced
Any other information related to your driving skill: _____________________________
__________________________________________________________________________
Car you will be driving: Year___________ Make___________________________________
Model__________________________________ Color__________________________________
Insurance Carrier (required)____________________________________________________
Policy #______________________________________________________________________
Car Number preferred (1st come, 1st served)_______________
Price includes lunch.
Additional lunches for guests are $12 per person per day.
Cancellations within 10 days of the event will not receive a refund.
A $25 administration fee will be assessed for all other cancellations.
| Driver 1: (Both Days) or (Saturday) or (Sunday) | $___________ |
| Driver 2: (Both Days) or (Saturday) or (Sunday) | $___________ |
| Extra Lunches: Saturday___________ Sunday___________ | $___________ |
| Total Enclosed | $___________ |
|
Make check payable to GWS-MBCA | |
| Print this form and send it and your check to: |
Joe Wozney 1625 Park Overlook Drive Reston, VA 20190 |