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Targa Sixty Six Registration Form 2019
MEMBERSHIP INCLUDES DRIVING PRIVILEGES FOR ONE MEMBER AND ONE IMMEDIATE FAMILY MEMBER PER ENTRY. PRIMARY MEMBERSHIP $2,300 INCLUDES 2 LUNCHES PER DAY. $250 LATE ENTRY FEE EFFECTIVE NOON 2/08/2019.
About:
Brian Redman's Targa Sixty Six
Date:
February 22nd - February 24th. 2019
Address:
Palm Beach International Raceway
17047 Beeline Hwy, Jupiter, FL 33478
Image
Entrant's Name
*
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email
*
Confirm
Entrant Phone
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Emergency Contact At The Track
*
First
Last
Emergency Contact Phone
*
###
-
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Race Shop Name if applicable
Race Shop Contact Name
First
Last
Race Shop Phone
###
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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
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Second Driver Phone
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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
Please select
0
1
2
3
4
5
6
Overcrew@$45
Please select
0
1
2
3
4
5
6
Extra Lunches Friday@$30
Please select
0
1
2
3
4
5
6
Extra Lunches Saturday@$30
Please select
0
1
2
3
4
5
6
Extra Lunches Sunday@$30
Please select
0
1
2
3
4
5
6
Total Saturday VIP Dinners@$130
Please select
0
1
2
3
4
5
6
Primary Membership $2,300. Lunches $30 per plate. Dinner. $130 per plate. Overcrew $45.
Saturday VIP Dinner.
Please select entree choice:
Guest 1
Please select
Meat
Fish
Vegetarian
Guest 2
Please select
Meat
Fish
Vegetarian
Guest 3
Please select
Meat
Fish
Vegetarian
Guest 4
Please select
Meat
Fish
Vegetarian
$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
Total
$0.00