Moncton Motor Sport Club

Promoting Grassroots Motorsport in the Moncton, NB Area

Slalom@Slemon On-line Entry Form

Competitor Information:

First Name:
Last Name:
Address:
City:
Province/State:
Postal/Zip Code:
Club:
Age:
Gender: Male Female
Driver's Licence:
Telephone #, Home:
Telephone #, Work:
Telephone #, Cell:
E-mail Address:
Web URL:

Vehicle Information:

Class:
Car #, 1st Choice:
Car #, 2nd Choice:
Car #, 3rd Choice:
Year:
Make:
Model:
Engine Size:
Colour:
Tires (Brand/Model):
Tire Size:
Shocks:
Wheels:
Oil:
Sponsor/Team Name:
Co-Driver's Name:
Co-Driver's Number:

Competitor Background Information:

Occupation:
Hometown:

How long have you been competing in autoslalom events?:    
Autoslalom achievements you are proud of:

Emergency Contact Information:

Contact Name:
Relationship:
At Event Site?: Yes No
Telephone #, Home:
Telephone #, Work:
Telephone #, Cell:

Entry Preferences:

Temporary Membership Required: Yes No
Banquet Meal Preference: Chicken Steak
T-Shirt Size: Small Medium Large XLarge 2XLarge

Registration Information:

Completed entries must be recieved by 4:00pm ADT, July 14th in order to qualify for the early entry fee of $160.00 CAD. After July 14th, the entry fee becomes $180.00 CAD.  Last day for withdrawal from the event and refunds is July 28th.  No refunds after this date.

All drivers must bring to registration: current valid drivers licence and club membership card.  Entrants, who are not a member of an affiliated club, or a member of the SCCA, are required to purchase a temporary membership for a fee of $20.00 CAD.

Minors: A minor release form (please obtain the proper form from you local region) and a notarized permission letter from the car owner must be presented at check-in.

BY SUBMITTING THE ENTRY FORM YOU ARE INDICATING THAT YOU AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

I agree to compete under the current CNSR AutoSlalom regulations and the supplementary regulations pertaining to this event.  I further affirm that the car I have entered complies with all requirements for the class and category in which it is listed above.  The entrant agrees to ensure that they, the driver, the owner, and all crew members understand and sign the waiver for this event.  This entry is not valid unless the RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT for this event has been signed by all registered herein (entrant, driver, owner, and all crew members).