Track Day Registration LNB .pdf

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Original filename: Track Day Registration LNB.pdf
Title: TrackDay_Registration_SD_6_14

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FONTANA TRACI< DAY

Fontana Autoclub Speedway I Thursday October 26th 2017 I 9:00am - 5:00pm

REGISTRATION FORM
To reserve your spot for the Fontana Track Day, participation fee must be paid in full. Space is
limited, registrations will be taken on a first come first served basis.
Please fill in the Registration Form and send it back by email: Events@LamboNB.com.

REGISTRATION

FIRST NAME

LAST NAME

GUEST FIRST NAME

GUEST LAST NAME

EMAIL

CELL

EMERGENCY CONTACT NAME
EMERGENCY CONTACT NUMBER

I

VEHICLE YEAR

MAKE

TRACK EXPERIENCE (CHECK ONE)

0BEGINNER

I

MODEL

D INTERMEDIATE D EXPERT

Regular Track Day Fee: $699 per participating car
Helmet Rental: $20 Each
1 helmet
2 helmets

D

D

CARDHOLDER NAME

Guest Fee: $30 per person

CC AUTHORIZATION FORM

BILLING ADDRESS
Cl1Y
CREDIT CARD 1YPE

Ov1sA

CREDT CARD NUMBER
CARD IDENTIFICATION NUMBER

-

0AmEx

-

I

STATE

0 MasterCard
-

I

I

ZIP

EXP. DATE

(3 DIGITS ON BACK OF CARD/ 4 DIGITS ON FRONTOFAmEx)

I hereby authorize Lamborghini Newport Beach to charge my card in the amount of $
for the Fontana T rack Day Experience.
DATE:

SIGNATURE:


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