EmailMe Form - Targa Sixty Six Registration Form 2019

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Entrant's Name *

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Confirm

Entrant Phone

### - ### - ####

Emergency Contact At The Track *

First Last

Emergency Contact Phone *

### - ### - ####

Race Shop Name if applicable

Race Shop Contact Name

First Last

Race Shop Phone

### - ### - ####

Race Shop Email

Cars attending: YEAR, MAKE & MODEL. Please contact us if you wish to bring more than 4 cars.

Car 1
Car 2
Car 3
Car 4

Parking Requirement Including Awning. Length X Width

Family/Crew Name 1

Family/Crew Name 2

Family/Crew Name 3

Membership includes passes for 4 people total. Driver plus 3.

Second Driver Name. Immediate Family Only.

First Last

Second Driver Email

Confirm

Second Driver Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Second Driver Phone

### - ### - ####

Overcrew. $45 per person for the weekend.
Does not include lunches.

Over Crew Name
Over Crew Name
Over Crew Name
Over Crew Name
Over Crew Name
Over Crew Name

Please fill out the fields below.

Primary Membership $2,300. Includes lunch each day for 2.

Additional Lunches $30 per plate.

Dinner $130 per plate. Speaker: Derek Bell

Membership includes 2 lunches each day Friday, Saturday & Sunday.

Primary membership includes driving privileges for 2 family members. *

Targa Primary Membership@$2,300
Overcrew@$45
Extra Lunches Friday@$30
Extra Lunches Saturday@$30
Extra Lunches Sunday@$30
Total Saturday VIP Dinners@$130

Primary Membership $2,300. Lunches $30 per plate. Dinner. $130 per plate. Overcrew $45.

Saturday VIP Dinner.
Please select entree choice:

Guest 1
Guest 2
Guest 3
Guest 4

$130 per plate for 3 course meal with reception, beer & wine.

Price

$ Dollars . Cents

If paying by check please make out to Intercontinental Events Inc.
Mail to:
Targa Sixty Six c/o Trish Mazzoni
950 Greenbriar Drive
Boynton Beach, FL 33435