NASCC RACING and SCHOOL REGISTRATION FORM - 2018 ICE RACE SERIES

Please print clearly. Print this form double-sided. Please fill out in advance.

First DriverFirst Name______Last

Address ______

Phone(h) __ (w) ______

E-mail ______

Competition Licence #______Driver’s Licence #(School Only)

Emergency ContactName ______Phone Relationship

Second DriverFirst Name ______Last

Address ______

Phone(h) __ (w) ______

E-mail ______

Competition Licence #______Driver’s Licence #(School Only)

Emergency ContactName______Phone Relationship

Race Car Car Number ______Transponder Number

Make______Model _____ Year Colour

Complete Make and Model for Race or School car, or squeeze in both if different cars used.

FEES AND RACE DATES ARE ON PAGE 2

Pre-register by completing this Registration Form (double-sided) and submitting to NASCC. Forward both to Mark Burroughbefore January 12, 2018, either at a club meeting, snail mail or email. Payment can be made by cash or check at the school or track! Season Packages 3 - 5 can also be paid for at Race 1 track-side registration. Individual race day entry fees can be paid for at track-side registration.

NASCCc/o Mark Burrough.

14615 114 Street(587) 783-2708

Edmonton, AB T5X 1G5

** Special note regarding insurance as per “WCMA Sporting Regulations - Race”

24. APPENDIX 1 - INSURANCE REQUIREMENTS

24.2. Ice Race Event Insurance Exclusions

24.2.b. The insurance policy does not apply to bodily injury, property damage or public liability arising out of melting, breaking or collapsing of ice on which racing programs are staged.

Sanctioned by: WCMA, Club Sponsor: NASCCPage 1

NASCC RACING REGISTRATION FORM / ENTRY FEES

All fees are payable by cash or cheque to NASCC.

Driving School Registration - $200 ($170 by Dec 14)c/w 1 day temporary NASCC membership

(mandatory for first-time racers)

Prepaid Registration / Entry fees

Includes Track Marshal Fund (TMF, $10 per car per day)

  1. Rookie Package 1, 5 races -$580

includes membership ($70), driving school ($200),

and one class entry for 5 races (save $190)

  1. Rookie Package 2, 5 races -$730

includes membership ($70), driving school ($150),

and two class entries for 5 races (save $190)

  1. Season Package 3, 5 races - $450

one driver, one class (save $50)

  1. Season Package 4, 5 races - $600

one driver, two classes (save $50)

  1. Season Package 5, 5 races - $550

two drivers, one class (save $50)

Race Day Entry Fees for Races 1 to 5:Races 67 at Lac La Biche:

Includes Track Marshal Fund (TMF, $10 per car per day)(paid at Lac La Biche)

A.One Driver, One Class ($90 + $10 TMF) - $100A. 2 days - $ 90 Total

B.One Driver, Two Classes ($120 + $10 TMF) -$130B. 2 days - $130 Total

C.Two Drivers, One Class ($120 + $10 TMF) - $130C. 2 days - $130 Total

D.add driver to 1-driver 1-class package prices at $30 per day

PAYMENTS

CH–Chevette CHSS–Chevette Street Stud NE–Neon MI–Miata NS-No Stud (Rubber) LS-Limited Stud

Driving SchoolJanuary 2021, 2017 $ Drive Lic. [ ] Vehicle Reg. [ ]

Season Package #12345$

RaceDateClassesComments

1.Jan 14, 2018CHCHSSNEMINSLS4WD$

2.Jan27, 2018CHCHSSNEMINSLS4WD$

3.Jan 28, 2018CHCHSSNEMINSLS4WD$

4Feb 10, 2018CHCHSSNEMINSLS4WD$

5Feb 11, 2018CHCHSSNEMINSLS4WD$

6 & 7 Feb 2425CHCHSSNEMINSLS4WD$

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