THANK YOU FOR PRE-REGISTERING!  

EVENT DATE:

DRIVER INFORMATION:

First Name*:    Last Name*: 

      *for NCCC members, name MUST match what is on your NCCC membership card
Address: 
City:    State:    Zip: 
Phone: 
Email: 
Club:       Membership Number: 

Emergency Contact:    Phone: 
Contact will be at event.

CAR INFORMATION:

Year:    Make:    Model:    Color: 
Class:      Car Number: 
  I am part of a multi driver car (Other Driver:  )  We would like the same  different run group.

Modifications:
None   Minimal  Extensive
Tires:
Under 200 rating  Over 200 rating

GENERAL INFORMATION: 
Have you autocrossed before?
    Yes  No

How did you find out about the event?

    NCCC East Ohio Website

    My NCCC club newsletter/meeting

    MyAutoEvents.com

    NORA Forum

      Other: 

NOTES:  1. All entrants MUST completely and truthfully fill out the registration form.  All entrants eighteen (18) years and older MUST also sign the Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement and any other release documents which maybe required by NCCC.  Entrants younger than eighteen (18) years old must have a parent or legal guardian present and submit a properly completed Parental Consent, Release and Waiver  of Liability, Assumption of Risk, and Indemnity Agreement and a Minor's Assumption of Risk Acknowledgment and any other release documents which may be required by NCCC.  2. All drivers must be properly licensed per Section 1.7.1. (Eligibility to Compete) of the NCCC Rulebook.

I Agree - I acknowledge that I will abide by all of the rules of the event. I also acknowledge that I will not partake of any alcoholic beverage,  until the end of the event, as proclaimed by the event chairperson.