EVENT REGISTRATION

Personal Info

First Name
Last Name
Email
Phone
Street Address
City
State
Country
Zip Code
Role	OwnerManufacturerBuilder
Association or Club Affiliation
Referred By
Company
Prior Experience Driving on a Roadracing Circuit (if none, write "none")
Emergency Contact Full Name
Emergency Contact Phone Number

Vehicle Info

Type	CarMotorcycle
Make & Model
DOT Approved?	YesNo
How is your vehicle powered?
Estimated Horsepower	CrankWheel
Weight
Seating Capacity
Please describe safety equipment (seatbelts, roll structures, etc.)

And Finally...

Do you want to participate in the SportElectric Time Trial? (fastest lap competition, not wheel-to-wheel racing)	YesNoMaybe
Any Comments?