PRE-REGISTRATION DRIVERS SCHOOL OR EVENT #1 ENTER BOTH AND SAVE!

NAME:______________________________________________________________________________

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 or NO (please circle) 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 MEMBERS DRIVERS SCHOOL - $20_____ EVENT 1-$20______ BOTH-$35______

SCCA MEMBERSHIP ONE YEAR - $65__________

NON-MEMBERS DRIVER SCHOOL - $25______ EVENT #1 - $25______ BOTH - $45______

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

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