-------------------(Pre-Registration Form / Only Needed if Driving in the Autocross)---------------------

If you intend on driving in the upcoming Autocross event, then we need to go ahead and get your
information entered into the computer systems.  This helps us budget towards the number of participants
as well as saves enormous amounts of time on the day of the event, in regards to registration.  If you
intend on driving, then please complete the following information and email it back as an attachment
to kent.barnard@cox.net to reserve your spot.  Please note that we may have a much larger turnout than
normal, and will be forced to cutoff the number of drivers at 100.  The first 100 Pre-Registered drivers
will be guaranteed their entrance in the event.


NAME: 

ADDRESS: 

CAR CLUB MEMBER? (of any registered Automobile Club(s) and if so, which one(s)): 

HOME PHONE: 

EMAIL ADDRESS (for contact on future events): 

EMERGENCY CONTACT PHONE NUMBER: 

VEHICLE YEAR / MAKE / MODEL: 

VEHICLE RUN CLASS (only if you have run previous events and know your classification):  

PREFERRED VEHICLE NUMBER:  


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