Member Registration 2012

    Cost for 2012 Media Day is $160 for members and $200 for guests. 

    First Name:
    Last Name:
    Street Address:
    City:
    State:
    Zip:
    Telephone:
    EMail:
    Primary Media Outlet:
    Emergency Contact Name:
    Emergency Contact Telephone:
    Where will you be staying:
    Attending Ride & Drive:
    Yes No
    Attending On-track Event:
    Yes No
    Attending Banquet:
    Yes No
    Menu Selection:
    Bringing Guest?:
    Guest Name:
    Guest Attending Tuesday Lunch:
    Guest Attending Wednesday Lunch:
    Guest Attending Banquet:
    Guest Menu Selection:
    Payment Method:
    Total Amount: $160.00
    Type What you See Above:
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