Labor Day Autocross Coles County Airport/Matoon IL
08-28-2010, 10:22 AM
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Melting Slicks
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St. Jude Donor '12-'13-'14-'15-'16
Labor Day Autocross Coles County Airport/Matoon IL
Saturday, September 4, 2010 Sunday, September 5, 2010 Hosting Clubs:
Low Speed 1 MW-167-131 Low Speed 5 MW-167-134 Northern Illinois Corvette Club
Low Speed 2 MW-135-132 Low Speed 6 MW-135-135 Northern Rays, Ltd
Low Speed 3 MW-351-133 Low Speed 7 MW-351-136 Windy City Corvettes
Low Speed 4 MW-351-165
Region:
PRE-REGISTRATION FORM
for
LOW SPEED EVENTS LABOR DAY WEEKEND SEPTEMBER 4 & 5, 2010
Make checks payable to NICC & mail with pre-registration & tech forms by August 30th, 2010, to:
Nancy Bailey, 2781 Be-Ver-Vue Road, Belvidere IL 61008-9702.
Host Clubs:
Event Site/Location:
No. Illinois, No. Rays, Windy City
Coles County Airport/Mattoon IL
Sanction #(s): MW-167-131/134 MW-135-132/135
MW-351-133/136/165
Registration (Car) Number/s: (Enter car number only if you have paid for a 2010 MW Region reserved #)
PRE-REGISTRATION:
ENTRY FEE for 7 event weekend Saturday & Sunday: � $65 1 Driver � $130 2 Drivers
ENTRY FEE for 4 event weekend Saturday Only: � $40 1 Driver � $ 80 2 Drivers
ENTRY FEE for 3 event weekend Sunday Only: � $30 1 Driver � $ 60 2 Drivers
DAY OF EVENT:
ENTRY FEE for 7 event weekend NCCC: � $70~1 Driver � $140~2 Drivers
ENTRY FEE for 7 event weekend NonNCCC: � $80~1 Driver � $160~2 Drivers
ENTRY FEE per event NCCC: � $11~1 Driver � $22~2 Drivers 1-2-3 or 4-5-6 Event � Sat or � Sun
ENTRY FEE per event NonNCCC: � $13~1 Driver � $26~2 Drivers 1-2-3 or 4-5-6 Event � Sat or � Sun
For registration use only:
Postmark Date: Date Received: Check# Cash or Check: $
Current NCCC card: Driver #1: Driver #2:
Current Drivers License: Driver #1: Driver #2:
Driver #1: NCCC #:
Address: Club Name:
City: State: Zip Code: Phone:
Driver #2: NCCC #:
Address: Club Name:
City: State: Zip Code: Phone:
E-Mail Address to send results to:
Whom do you wish to notify in case of Emergency? (Leave blank if a Club member, at the event, will act as your contact person.)
Name: Relationship: Phone:
Fill out below for all events:
Year of Car: Make: Style:
Class normally entered in:
(List any changes that may affect classification on reverse side of this sheet.)
Factory Rated HP: Displacement: Transmission type:
Drive Axle Ratio:
Tire Size & Type:
F:
R:
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 maybe required by NCCC. 2. All drivers MUST be properly licensed per Section 1.7.1. (Eligibility to Compete) of the NCCC
Rulebook
7/15/
Low Speed 1 MW-167-131 Low Speed 5 MW-167-134 Northern Illinois Corvette Club
Low Speed 2 MW-135-132 Low Speed 6 MW-135-135 Northern Rays, Ltd
Low Speed 3 MW-351-133 Low Speed 7 MW-351-136 Windy City Corvettes
Low Speed 4 MW-351-165
Region:
PRE-REGISTRATION FORM
for
LOW SPEED EVENTS LABOR DAY WEEKEND SEPTEMBER 4 & 5, 2010
Make checks payable to NICC & mail with pre-registration & tech forms by August 30th, 2010, to:
Nancy Bailey, 2781 Be-Ver-Vue Road, Belvidere IL 61008-9702.
Host Clubs:
Event Site/Location:
No. Illinois, No. Rays, Windy City
Coles County Airport/Mattoon IL
Sanction #(s): MW-167-131/134 MW-135-132/135
MW-351-133/136/165
Registration (Car) Number/s: (Enter car number only if you have paid for a 2010 MW Region reserved #)
PRE-REGISTRATION:
ENTRY FEE for 7 event weekend Saturday & Sunday: � $65 1 Driver � $130 2 Drivers
ENTRY FEE for 4 event weekend Saturday Only: � $40 1 Driver � $ 80 2 Drivers
ENTRY FEE for 3 event weekend Sunday Only: � $30 1 Driver � $ 60 2 Drivers
DAY OF EVENT:
ENTRY FEE for 7 event weekend NCCC: � $70~1 Driver � $140~2 Drivers
ENTRY FEE for 7 event weekend NonNCCC: � $80~1 Driver � $160~2 Drivers
ENTRY FEE per event NCCC: � $11~1 Driver � $22~2 Drivers 1-2-3 or 4-5-6 Event � Sat or � Sun
ENTRY FEE per event NonNCCC: � $13~1 Driver � $26~2 Drivers 1-2-3 or 4-5-6 Event � Sat or � Sun
For registration use only:
Postmark Date: Date Received: Check# Cash or Check: $
Current NCCC card: Driver #1: Driver #2:
Current Drivers License: Driver #1: Driver #2:
Driver #1: NCCC #:
Address: Club Name:
City: State: Zip Code: Phone:
Driver #2: NCCC #:
Address: Club Name:
City: State: Zip Code: Phone:
E-Mail Address to send results to:
Whom do you wish to notify in case of Emergency? (Leave blank if a Club member, at the event, will act as your contact person.)
Name: Relationship: Phone:
Fill out below for all events:
Year of Car: Make: Style:
Class normally entered in:
(List any changes that may affect classification on reverse side of this sheet.)
Factory Rated HP: Displacement: Transmission type:
Drive Axle Ratio:
Tire Size & Type:
F:
R:
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 maybe required by NCCC. 2. All drivers MUST be properly licensed per Section 1.7.1. (Eligibility to Compete) of the NCCC
Rulebook
7/15/
