Registration Form
First Name: Last Name:
Address:
City: State: Zip:
Telephone: Email:
Club Affiliation (if any):
Car Year: 1984 1985 1986 1987 1988 Car Model: Coupe/2M4 Indy Pace Car SE 4 cyl SE 6 cyl GT Formula Other Mileage:
Classification(see definition of classes): Daily Driver Stock Notchback Stock Fastback Custom/Modified Super Modified 4cyl/6cyl Notchback Super Modified 4cyl/6cyl Fastback Super Modified 8 cyl Kit Car/Rebody
Registration Costs
Registration Fee:...$55 / car. QTY:
If you would like to attend the event but are not bringing a car please enter "0", otherwise leave as "1".
Addtl Car Fee: $25 / car. QTY:
1st Additonal Car Year: 1984 1985 1986 1987 1988
1st Additonal Car Model: Coupe/2M4 Indy Pace Car SE 4 cyl SE 6 cyl GT Formula Other 1st Additionl Car Mileage:
Classification(see definition of classes): Daily Driver Stock Notchback Stock Fastback Custom/Modified Super Modified 4cyl/6cyl Notchback Super Modified 4cyl/6cyl Fastback Super Modified 8 cyl Kit Car/Rebody Additional Car 1 Driver:
Additional Car 2 Year: 1984 1985 1986 1987 1988
Additional Car 2 Model: Coupe/2M4 Indy Pace Car SE 4 cyl SE 6 cyl GT Formula Other Additional Car 2 Mileage:
Classification(see definition of classes): Daily Driver Stock Notchback Stock Fastback Custom/Modified Super Modified 4cyl/6cyl Notchback Super Modified 4cyl/6cyl Fastback Super Modified 8 cyl Kit Car/Rebody Additional Car 2 Driver:
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