2004 Driving Year Entry Form

Please print this form, fill it in, and mail it to us at the address below.
Payment in full must be received two weeks prior to event.
NEW! Pay by VISA or MASTERCARD!

For more information, please call (615) 354-5576 or (314) 330-6449

Please print clearly:

Participant Name:____________________________________________

Event Date: Nov 13-14, 2004     Location/Track: Carolinas Motorsports Park, Kershaw, SC

Driving Group (circle one):     Novice          Intermediate            Expert 

NOVICE-ON-TRACK: This program is designed for the sports-minded driver with little or no on-track driving experience. Sessions alternate between classroom instruction addressing proper lines and vehicle handling when navigating a racetrack and on-track driving sessions. On-track sessions begin with lead-follow at highway speeds. Each following session addresses more aggressive on-track driving.
INTERMEDIATE: This program is designed for the experienced driver with some on-track driving experience. Additional instruction is available for better driving and track navigation.
EXPERT: This program is designed for licensed racers or very experienced drivers with on-track driving experience.

Car Year, Make and Model: _____________________________________

Address ____________________________________________________

City, State, Zip _______________________________________________ 

Phone Number(s)
Home_______________Work_______________Cell_________________

Email Address:_______________________________________________ 

Emergency Contact:  Name______________________Phone___________

Fees Due: __________
One driver and one car:
$200 one day - (circle one)   Saturday   Sunday
$350 two days
After October 30, 2004, add late fee of $25 for one day, $50 for two days
A discount may be available for more than one family member in a car. Contact Phil Wicks Driving Academy at the number or email below for details pertaining to your situation.

Discount Group: Second Strike

Are you interested in camping: (circle one)   Yes   No

Payment Method:

Visa / MC Card No. _____________________________ Exp. date: ______

Signature: ___________________ Name on card: ___________________

Cashier’s Check _____  Money Order _____ Personal Check ____

Print this form, add your information and mail it with your payment to:

Phil Wicks Driving Academy
1012 Davidson Road
Nashville TN 37205

PHIL WICKS DRIVING ACADEMIES
(314) 330-6449  racerwicks@aol.com