EmailMe Form - Targa Sixty Six Registration 2022

Image

PLEASE NOTE THAT WE WILL CONTACT YOU CLOSER TO THE EVENT DATES TO GET ADDITIONAL INFORMATION:
GUEST NAMES, MEALS REQUIRED, CARS BEING ENTERED ETC

Name *

First Last

Entrant Phone *

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

Address *

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

Race Shop Name if applicable. (So we can inform of load in times, parking requirements etc).

Entrant Email *

Car 1. Make/Model/Year

Car 2. Make/Model/Year

Car 3. Make/Model/Year

Emergency Contact At The Track *

First Last

Emergency Contact Phone *

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

Race Shop name if applicable

Race Shop Phone

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

Race Shop Email

Membership/Registration. $2,600 *

$ Dollars

We can offer you a credit for the following year/event or if you prefer a refund of the registration cost minus handling fees of $200