Midwest Region Memorial Day Weekend Fundraiser 2019 Registration Form

Sanction(s): 21 events Sat-Sun-Mon, May 25: 7 events Saturday, May 26: 7 events Sunday, May 27: 7 events Monday
Entrant # 1 Car Number: Registration $
Entrant # 2 Car Number: Registration $
 Total$

1 Personal Information
 
Entrant # 1:
NCCC number:      
(Format: RR-CCC-MMMM)
First: Last:
Address:
City: State: Zip:
Phone: Email:
 
Entrant # 2:
NCCC number:      
(Format: RR-CCC-MMMM)
First: Last:
Address:
City: State: Zip:
Phone: Email:
 

2 Car InformationNon-Corvettes are either Metal (Men's Class) or LMetal (Ladies Class) and are NOT included in NCCC Results.
 Entrant #1:Entrant #2:
  Year: Make: Model: Class:          Year: Make: Model: Class:         

3 Events
21 events Sat-Sun-Mon Entrant 1: $150.00                                                                     21 events Sat-Sun-Mon Entrant 2: $150.00                                                                     
May 25: 7 events Saturday Entrant 1: $60.00                                                                     May 25: 7 events Saturday Entrant 2: $60.00                                                                     
May 26: 7 events Sunday Entrant 1: $60.00                                                                     May 26: 7 events Sunday Entrant 2: $60.00                                                                     
May 27: 7 events Monday Entrant 1: $60.00                                                                     May 27: 7 events Monday Entrant 2: $60.00