Signup Form

Slowpokes Inc.
Open Track Driver’s Education Event
Mid America Motorplex

Cost:	$295 (+$50 late fee if after August 30th)
Format:	Open Track Get as much seat time as you can safely handle!
Participants:	40 cars ONLY (maximum registration)
Requirements:	Prior High Speed School Experience Snell 90 or newer helmet Tech: Nord Stern certification or equivalent (inquire if in doubt)
Contacts:	Fred Jacobberger -- 952-948-0600 Linda Schmid -- 952-943-9567
Each driver must have completed a training event at BIR or have prior driver’s education events at BIR. This event will be an open track event with each driver getting as much track time as they can safely handle.
Date of Event:	September 5 - 6, 2009
* Indicates required fields
* Driver:
Co-Driver(s):
* Address:
* City, State, Zip:
* Email Address:
Phone Number:

* Car Color/Make/Model/Year:

* Date/Location of Tech:

* BIR or Equivalent Experience:

* Emergency Contact Name:
* Emergency Contact Phone:
* Method of Payment:	Check