EmailMe Form - NW Gold Cup Pre-Registration form

Name *
Address *

Street Address City State / Province / Region Postal / Zip Code Country
Phone *
### - ### - ####
Email *
Emergency Contact Name and Phone#
Kart Number *
Transponder Number
Transponder Rental Fee $25.00
IFK Number *
IFK Number Expiration Date *
Entry Information
Rotax Membership#
If applicable
First Race Class *
Second Race Class
Third Race Class
Fourth Race Class
Friday Practice - $30.00 fee *
Yes
No
Number of Non-Participant Pit Pass for Entire Event
(Children under 4 years of age are free)
Notes
Please provide any special details or comments
How do I Submit Payment?
Once you submit this form please call Debbie Hettick with your credit card number to pay for event 206-229-1994.