California Sports Car Club
Double National/Dbl. Rest. Reg.
Jan. 25, 26-27, 2008

2005 Entry Form

Event: 
 Double National/
Dbl. Rest. Regional
	Date:
Jan. 25, 26-27, 2008
	Late Entry Deadline:
Jan. 19, 2008	Sanction #s: 
TBD
08-N-07-S
08-N-08-S
08-RS-07-S
08-RS-08-S
	Track / Location:
CALIFORNIA SPEEDWAY	
   DBL. REST. REGIONAL                                        DOUBLE  NATIONAL		
Log Book ID
	Make
	Model
	Year
	Color
	Class
	Car Number Choices	
						1st  	2nd  	3rd  	
Transponder # - Required  	E-mail
	Registrar Use
Only	
Driver's Name (Please print legibly)
	Daytime Phone
	Run Group	
Address
	Evening
	Car #	
City
	State
	Zip Code
	Fax
	Class	
Membership Number
	Expiration Date
	License Grade
 Reg    Nat    Dual    FIA    Novice 	Member/License OK	
Region of Record
	Cal Club Associate or Lifetime Member?       Yes   No	If Renting, From Whom?
	Tech Card Given?	
Entrant ( if different than driver )
Name
Address
City, State, Zip	Entrant Member #  AND Expiration Date	Waiver Signed?

		Payment Type:

 Cash
 Check
 Credit Card

Total Paid

$___________

Registrar Initials	
Sponsor(s) 		
In Emergency, notify?
	Phone
	At Track?
Yes      No		
Circle Payment Type, Payable at Registration (PLEASE, bring card to registration.)                               Check	    Visa	          MasterCard 	     Cash
Card #                                                                                                                 Expiration Date: 			

It is agreed that the entry, if accepted, shall be a contract between the Driver/Entrant & the SCCA/California Sports Car Club Region under which the above car & driver will take part in the competition described, unless prevented by force beyond control of the Driver/Entrant.  This event will be conducted under the SCCA 2008 General Competition Rules & California Sports Car Club 2008 Supplementary Regulations and the Entrant & Driver agree to abide by these rules. All participants must sign a release agreement at Registration before entering the track facility.	

Driver Signature _____________________________________    Entrant Signature  ________________________________________	
	Entry Fees:	SM/SRF / FSCCA / SCCASR Fees:	Late Fees:	Total Fees:	PLEASE SEND ENTRY TO:

Cal Club Registrar
18202 Cal Club Drive
Buttonwillow, CA  93206

Phone:  661.764.5945
Fax:      661.764.5944
E-Mail: calclubhq@aol.com

Dbl. Rest. Reg.
Double National
	$360.00
$410.00
	$10.00
$20.00
	$40.00
$40.00

Worker Donation
     TOTAL	$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________
$ ___________________		

	

2005 Entry Form

USE OF MEDICAL FORMS DISCONTINUED BY THE S.C.C.A.