2021 September Palmer CRE Entry Form.xlsx

	A	E	F	I	J	K	L	M	O	P	R	S	T	U	W	X	Y	AA	AB
1
2	SCHEDULE OF ENTRY FEES			NEW ENGLAND REGION, SCCA											MAKE CHECKS PAYABLE TO:
3	Early Entry Fee		$ 295.00	NEW ENGLAND REGION, SCCA											New England Region, SCCA
4	Regular Entry Fee*:		$ 345.00	Pig Roast Weekend SCDA1.COM Club Racing Experience 21-CRE-20481											US Funds only
5
6															MAIL:		Marilyn Freeman
7																	188 Rocky Hill Road
8																	Brewster, MA 02631
9			$______														msf.ner@gmail.com
10	Voluntary Contribution to Workers' Fund																508.561.2188 (can receive text)
11	Voluntary Contribution to Workers' Fund		___________	Palmer Motorsports Park
12	Total Enclosed		___________	58 West Ware Rd, Palmer, MA													Please - no phone calls after 10PM
13	* See Supplemental Regs for Details																Please - no phone calls after 10PM
14				Sept 10-12, 2021													Express Mail must be
15																	"NO Signature Required"
16	Except as modified by the enclosed Supplemental Regulations, this event is held under the SCCA Club Racing Experience rules.
17	Make	Model			Color				Class		Transponder #						Number Request: choose 3
18																	/ /
19																	/ /
20
21	Driver									SCCA Member? Yes / No (circle one)								OFFICIAL USE ONLY
22										SCCA Member #(if yes):								OFFICIAL USE ONLY
23	Email									Phone								Group #
24
25	Comp License # (if applicable)						Grade			Exp date			Region
26
27	Address (City/State/Zip)																	Car #
28
29
30
31																		Class
32
33
34	Emergency Contact: Name									Phone				At Track?
35														YES / NO
36	Address									Relationship								Fee Paid
37
38	Crew Members: (3 free, addt'l crew $10 ea.)						Release #									Release #
39	1																	Money Rec'd @ Track
40	2																	Money Rec'd @ Track
41	3
42	MINOR PARTICIPANTS
43	MINOR PARTICIPANTS
44	I agree to enter this event which is held under the current General Competition Rules of the Sports Car Club of America, as amended by FasTrack and the Supplementary Regulations pertaining to this event. I further confirm that the car which I have entered complies with all requirements as specified in the CRE Rules for the class, category and race in which it is entered above.																		Release #
45
46
47
48
49	Signature Driver							Date
50
51	TIMING AND SCORING INFORMATION - MUST BE COMPLETED BY DRIVER on late entry only																	Group #
52	MAKE/MODEL/YEAR											TRANSPONDER #
53
54	COLOR					CLASS						REGION OF RECORD						Car #
55
56	DRIVER NAME											SCCA MEMBERSHIP #
57																		Class
58	ADDRESS (STREET/CITY/STATE/ZIP)
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100