EmailMe Form - OFFICIAL USTCC ENTRY FORM

Name *

First Last

Address

Street Address City State / Province / Region Postal / Zip Code Country / Region

Eve Phone

### - ### - ####

Day Phone *

### - ### - ####

Email *

Drug Allergies

Emergency Contact *

Emergency Contact Phone *

### - ### - ####

NASA Competition License Expiration *

MM / DD / YYYY

NASA Membership Expiration

MM / DD / YYYY

NASA Membership Number *

What is the length and width of your trailer and awning area that you would like to request for paddock parking?

Race Information

Car Make and Model *

Car Year

Car Engine CC

Car Color

Select Class *

Touring Car class

GT class

Sportsman class

Super Touring class

Declare your HP number. If you go over, you will be disqualified so pick carefully. *

Car Number Preference *

First Choice
Second Choice
Third Choice

Sponsor

MYLAPS Transponder Number *

I understand that this event is governed by the Club Codes and Regulations and USTCC rules and in cases of dispute the decision of the Race Director or Event Director is final.
I have been examined by a physician and am physically fit to participate in a high stress and physically demanding sporting event. I am not suffering from any diseases or disorders or under any drugs, legal or illegal, that would affect my performance at this event. I understand that this activity is not recommended for pregnant women.
I agree to allow NASA and USTCC and/or its sponsors to use my name and likeness in any manner for publication.
This event organized by Gogogear International, Inc. DBA United States Touring Car Championship.

There is no cash prize money for Fontana, Las Vegas and Mazda Raceway rounds and any doubleheader rounds.

I have read and understood the above *

Yes

No