2009 Event Registration

Saturday, September 26th @ MAM *	Yes No
Sunday, September 27th @ MAM *	Yes No
First Name *
Last Name *
Home Phone *
Mobile Phone
E-mail Address *
Street Address *
City *
State *
Zip Code *
Car Year, Make, Model *
Please describe your experience level. Valid responses would be; BEGINNER, NOVICE, INTERMEDIATE, EXPERIENCED or PRO. Extra space is provided if you would like to explain further. *
I am aware that driving or riding in an automobile on a race track, even in a non-competitive driver education program, open track event, testing, or otherwise, is a hazardous activity involving a high-degree of risk of serious injury or death. I am voluntarily participating in such activities with knowledge of the danger involved and hereby agree to assume any and all risks of injury or death resulting from this activity. Please check YES here to indicate that you you HAVE CAREFULLY READ THE ABOVE RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND AGREE TO IT OF MY OWN FREE WILL. *	Yes No