NECC Event Registration

Please make your selections:

Price

Package 1: All three events. Time trials, drags and autocross.
     Thursday, June 16, 2011 - Time trials at Putnam Park,
     Friday, June 17, 2011 - Drag racing at Muncie Dragway, and
     Saturday, June 18, 2011 - Autocross at Connersville..
$ 307.00

Package 2: Two events. Time trials and drag racing.
     Thursday, June 16, 2011 - Time trials at Putnam Park, and
     Friday, June 17, 2011 - Drag racing at Muncie Dragway
$ 273.00

Package 3: Two events. Time trials and autocross.
     Thursday, June 16, 2011 - Time trials at Putnam Park, and
     Saturday, June 18, 2011 - Autocross at Connersville.
$ 238.00

Package 4: Two events. Drag racing and autocross.
     Friday, June 17, 2011 - Drag racing at Muncie Dragway, and
     Saturday, June 18, 2011 - Autocross at Connersville..
$ 108.00

Individual Selection: Time trials.
     Thursday, June 16, 2011 - Time trials at Putnam Park.
$ 219.00

Individual Selection: One event. Drag racing.
     Friday, June 17, 2011 - Drag racing at Muncie Dragway.
$ 79.00

Individual Selection: One event. Autocross.
     Saturday, June 18, 2011 - Autocross at Connersville.     .
$ 39.00

Individual Selection: Taste of Track.
     Thursday, June 16, 2011 - Taste of Track at Putnam Park.
$ 29.00

Clear-out the Package Selections Above.                            Amount Due:

$

Please tell us about yourself and your car:

Yourself:

First Name

Middle Initial

Last Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

E-mail Address

Emergency Contact Name

Emergency Contact Phone

Your car:

Year

Make

Model

Body style (e.g. coupe)

Color

License tag

State

Engine manufacturer

Number of cylinders

Displacement

Original HP (Factory)

Current HP (Estimated )

Transmission (e.g. 5 speed)

If you are registering only for an NECC car show, then you can skip the Track Drivers Questionnaire.

More Questions! (Track Drivers Questionnaire)

Mandatory information for all drivers in moving events (time trials, etc):

Are you at least 18 years old?
Yes No (If NO, parental consent req'd)

Your driver license number

License State / Province

Race car number

Name of car owner

Do you wish to be timed?

After each event, we post a list of timings on our website. The list is sorted by driver name. May we include your name on this exhibit?

Please provide the following additional information about your car:

Engine modifications

Suspension modifications

Tires

NECC track class (if known)

Click for class info!

Will another driver be using this car at the events for which you registered above? Yes No

2nd driver's name

For which events?

Beware: NECC has a two-driver per car limit. Each driver must register separately.

Do you wish to be grouped with novice drivers?

Yes or no

Click on the Submit button to send your registration to NECC. You should be automatically directed to a "Thank You" page. If not, then we did not receive your registration.

If all else fails, you can fill out this web-page, print it out, and mail it in with the payment to Northeast Corvair Council (NECC) c/o John Ryall, Registrar, 14 Mishawum Drive, Dartmouth, MA 02748.