Midwest Region

October Fundraiser

Saturday, October 6, 2018 5 Low Speeds MW-205-001~005

Sunday, October 7, 2018 5 Low Speeds MW-205-006~010

Many thanks to Crossed Flags Corvette Club for donating the sanctions.

Location: Rantoul Aviation Center 6 Aviation Center Drive Rantoul, IL 61866

Entry Fees: Pre-Registered: $10/event, $50/day, $100 for both days. See Pre-registration Form on page 2; must be received by Sept. 29, 2018. Day of Event: $12/event, $60/day; or $120 for both days.

Click here for ONLINE REGISTRATION You are not pre-registered at the discount rate unless your payment is received by Sept. 29.

Saturday Sunday

Registration: 8:00 AM to 9:00 AM 8:00 AM to 8:30 AM

Tech: 8:00 AM to 9:15 AM 8:00 AM to 8:30 AM

Drivers Meeting: 9:30 AM 8:45 AM

First Car Out: After drivers meeting After drivers meeting

Chairperson: Ray Bair, Midwest Region RCD

17710 Marti Rd, Mokena, IL 60448-8783

Event Info:

Drivers must show NCCC Card and valid Driver’s License.

Car numbers assigned by Registration. MWR members requesting numbers other than those assigned will be charged per MWR Rules.

No Alcohol on Premises.

Pets must be on leash.

Overnight RV & trailer parking is permitted.

Midwest Region Members will be asked to work.

Closed Exhaust only. 103db Limit.

Corvette Club of Illinois will provide the food con-cession benefitting charity.

Passengers allowed per NCCC rules, but 16 years old minimum, with a driver’s license.

Lodging:

Room block reserved at the

First Heritage Inn

217 892-9292 http://heritageinn.magnusonhotels.com/

Alternate: Super 8

274 243-0200

Midwest Region Fundraiser Registration Form

Mail completed Registration Form and Check Payable to “NCCC - Midwest Region” to:

Karen Hottenrott Pre-registration and payment PO Box 296 must be received by Sept. 29, 2018

East Troy, WI 53120 to qualify for the lower price

ENTRY FEE for 10 event weekend: $120 or $100 (Mailed) 1-DRIVER $240/$200 2-DRIVERS

ENTRY FEE for 5 events Oct. 6 only: $60 or $50 (Mailed) 1-DRIVER $120/$100 2-DRIVERS

ENTRY FEE for 5 events Oct. 7 only: $60 or $50 (Mailed) 1-DRIVER $120/$100 2-DRIVERS

Driver #1 Name: Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

Driver #2 Name: ____________________________ Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

Driver #3 Name: ____________________________ Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

Driver #4 Name: ____________________________ Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

E-mail address:

Address, if not as in the NCCC Database.

Street: City: State: Zip Code:

Emergency Contact Information, if not at event:

Name: Relationship: Phone:

Car Information:

Stock Transmission Y N circle answer

Stock Drive Axle Ratio Y N circle answer

Requested Class:

For registration use only:

Postmark Date: Date Received: Check # Cash: $

NOTE: All entrants MUST truthfully complete the registration form. All Entrants MUST sign the RELEASE AND WAIVER OF

LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT and any release documents required by NCCC. Entrants

younger than eighteen (18) years must have a parent or legal guardian present and submit a properly completed PAREN-

TAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT and a MINOR’S AS-

SUMPTION OF RISK ACKNOWLEDGMENT; and any release documents required by NCCC. All Entrants MUST show a