Drivers Education Registration Form

Venue Date Amount

VIR International Raceway 10/11 $295.00

Registrations will be accepted on first come first serve basis. Please remember that your spot is not held until your $295.00 registration fee is paid. Registration fees are non-refundable. Event will be held rain or shine. Mail registration with check payable to “Euroclassics Porsche”, c/o Mark Cooke, Euroclassics Porsche, 11900 Midlothian Turnpike, Midlothian, VA 23113.

Car and Driver Information:

Name: ______Telephone: ______

(Driver) (Day) (Evening)

Email: ______PCA Region & Member #: ______

Address: ______

(No. & Street) (City, State, Zip)

Car: ______

(Make) (Model) (Year) (Color) (Modifications)

Driving Experience:

______/______/______/______

(PCA DE Events) (PCA Autocross Events) (BSR, Bondurant, etc.) (Total)

Car Restrictions:

·  All Student cars much have two seats with properly installed equal restraints for driver and passenger.

·  All cars with modifications that exceed those permitted for the “stock” or “prepared” classes by PCA Club Race Rules must have a roll bar or roll cage that meets PCA Club Race specifications.

·  All cabriolets or open top cars must have a roll bar that meets PCA Club Race specifications to proceed past the pace car driving group. All loose items and equipment such as car phones, radar detectors, etc. must be removed from the car.

·  Cars must pass all technical inspections prior to and during each event. Pre-event technical inspection forms must be completed by authorized personnel. Self signed tech forms will not be accepted.

Dress Restrictions:

Loose fitting shoes (loafers, sandals, open heel shoes, etc.) will not be permitted. Natural fiber or flame retardant long pants and long sleeve shirts are required. Approved Snell SA95 or SA2000 helmets are also required to proceed past the pace car driving group. Please dress comfortably and appropriately for expected weather conditions at the track venue.

Driving Restrictions:

Each driver must be at least 18 years of age and possess a valid driver’s license that much be presented at the event. Any minor attending the event will need a “junior Participate Waiver” signed by BOTH parents.

Certification:

I hereby certify that I have no known physical or mental conditions that might jeopardize myself or others if I participate in this event.

Driver: ______

(Signature) (Date)