SEASON PRE REGISTRATION

By pre registering you save time, money and makes the registration at events easier. The pre registration is good for all six events, not counting the BFG in August.

Events included in the season pre registration are

April 9^th

May28th

June 11^th

July 16^th

September 4^th

October 8th

Mail registration form with payment to:

Mike Moore

West 239 North 5886 Maple Ave

Sussex, WI 53089

Season Championship presented by

Schlossmann’s Dodge City / Honda City

SEASON PRE-REGISTRATION

NAME:______________________________________________________________________________

E-MAIL ADDRESS_______________________________________________________

DRVIER LICENSE NUMBER: __________________________________________________________

ADDRESS: __________________________________________________________________________

CITY/STATE/ZIP:______________________________________________________________________

PHONE:________________________ E-MAIL:_____________________________________________

CAR YEAR:_________ MAKE:_________________ MODEL:_________________________________

ENGINE SIZE:_______________ CAR MODIFICATIONS________________________________

CAR COLOR: ____________ CAR CLASS:_______________ NOVICE DRIVER? YES NO

DRIVING ON STREET TIRES? YES NO à IF YES, REAR or FRONT WHEEL DRIVE

PERMANENT CAR NUMBER: CHOICE #1_________ #2_________ #3_________

SCCA MEMBER NUMBER/EXP DATE: _________________________________________________

NOTE: You must present your SCCA Card at Registration to receive discount listed below.

SCCA MEMBER SEASON PRE REGISTRATION PASS (6 EVENTS, BFG IS EXTRA)$100_____

MAKE CHECKS PAYABLE TO: MILWAUKEE REGION SCCA AMOUNT ENCLOSED: $__________