Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Namba #
Home Phone
E-mail

SEI will be added to invoice if Namba # is not used at signup

RACER FEES:
$30.00 FIRST Class (Includes Lunch on Saturday and Sunday)
$7.00 each additional Class
$10.00 Single Event Insurance (SEI for non-NAMBA members)

 

Select any of the following options that apply: