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MSCC GUEST DRIVER ENTRY FORM

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MSCC GUEST DRIVER ENTRY FORM Powered By Docstoc
					                           AUTOMOBILE OPEN TRACK DAY ENTRY FORM

Open Track Date

Name

Street                              City

State                      Zip

Phone                                      E-Mail

Emergency Contact Person                                                       Phone
Check one level of Participation: if no track experience you must take New/Driver Orientation Course.

   BEGINNER                   INTERMEDIATE                  ADVANCED                   COMPETITOR
Check one level of Experience:
   None          Driving School         Autocross          Track Days        Club/Pro Racing


Club Affiliation                                                Competition License #

Driving Schools Attended:



Please list the vehicle/motorcycle that you plan to drive, including type (Street, Track, Race)




Automobile Open Track Day Fees:
  Monday-Thurday in Advance $225                 Monday-Thursday day of $275
   Friday-Sunday in Advance $250                 Friday-Sunday day of $300
   New Rider/Driver Orientation Course *additional $100


Payment Type:


CC#                                                    Exp. Date                            Card Code


Electronic Signature                                                          Date

         Save Form and Email to: anita@gorally.com               ‘or’         Print and fax to: 352-473-0105

  7266 Airport Rd, Keystone Heights Air Park, Starke, FL 32091 Ph: 352-473-2999 Fax: 352-473-0105

				
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posted:7/22/2011
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