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GCRS REGISTRATION FORM

CIRCUIT GRAND BAYOU 

GULF COAST RACE SERIES

 

PLEASE PRINT                           DATE:  __________    

 

Driver’s Name_________________________________

 

Driver License State ____   #________________

 

Email address: ____________________________________________

 

Address: _____________________________________

City: __________________State: _____ Zip: ________

 

Telephone #: (Home) _______________________________ (Cell): _________________________________

 

In Case of Emergency: 

 

Contact Name_______________________________

Phone Number____________________________

 

Car Info:  Year & Model____________________________ Color: ________________________

 

Indicate Car Number: 1st Choice_______ 2nd Choice______ 3rd Choice________

 

 

Racing Class (Circle One):          

 Red Bracket              Yellow Bracket             Spec Miata             Formula              Production GT1         Production GT2                Production GT3

 

TRANSPONDER #:  ____________________

                                                           

I hereby certify that I have no known physical or mental problems which might jeopardize others or me if I participate in this event.

 

Driver’s Signature _______________________________________________ Date _________________

 

 

THE CIRCUIT AT GRAND BAYOU RESERVES THE RIGHT TO REFUSE ANY APPLICATION.

 

 

REGISTRATION FEE

 

______Test & Tune day plus Race day - $310         

______Race day only - $165

                                                                                   

Cash is accepted or make check payable to:   

Circuit Grand Bayou, LLC

CASH __________                CHECK # _________                            AMOUNT _________

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