Lime Rock Park
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John Stim Memorial(Saturday
Morning)
Dave Riggi Memorial (Saturday
Afternoon)
Double Regional Race
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Mohawk Hudson
Region
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Sanction
Number: 07-RS-162-S(Stim
Memorial)
07-RS-163-S (Riggi Memorial)
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May 18-19, 2007
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NARRC & NYSRRC
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Registrar’s
Use Only
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Except as modified by the enclosed
Supplementary Regulations, this event is held under the SCCA General
Competition Rules
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Entry Fee: $399 same driver both Regional Races,
$350 any driver one Regional Race
SRF, FSCCA and SRSCCA add $10 per race Compliance
Fee
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RACE
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Saturday Morning __ ($350)
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Saturday Afternoon__($350)
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Both Regional Races____($399)
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Checks Payable to:
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Mohawak Hudson SCCA
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Visa/Master Card on-line or at Track
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Mail Entry To: Nancy Boice
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10 Pheasant Run
Ballston Spa, NY 12020
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Email: Mohudregs@nycap.rr.com
518-885-0841
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CAR #
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DRIVER INFORMATION
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Name: ________________________________________________________
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Date of Birth:___________
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Street/City/State: _____________________________________________
________________________________________________________________
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Email: ________________________________________________________
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Phone No: ________________
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SCCA License No: _____________________________________
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Region of Record: _________
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License Grade: _______________________________________________
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Expiration Date: ___________________
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CLASS
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SPONSOR\ENTRANT INFORMATION
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Sponsor: _____________________________________________________
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Entrant Name: ________________________________________
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SCCA Mbr #: _______
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Entrant Address: _____________________________________________
________________________________________________________________
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Rental? From Whom? _________________________________
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REGION
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CAR INFORMATION
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Transponder #: ____________________________________________________
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Class: __________
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Make/Model: _____________________________________________________
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Color: ___________
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Desired Numbers: _________/__________/________
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FEE PAID
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EMERGENCY CONTACT INFORMATION
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Name: __________________________________________________________
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Address: _______________________________________________________
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At the Track: ______
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Phone Number: _______________________________________________
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Relationship:_______
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CREW INFORMATION
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To enter the pit area you must be 16 years of age and an
SCCA member with proper credentials per GCR 10.1.4. Only Driver or Crew
Chief can modify crew list. Crew Chief is first listed crew member.
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Name: _______________________________________________
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SCCA Mbr #: ____________
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Name: _______________________________________________
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SCCA Mbr #: ____________
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Name: ________________________________________________
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SCCA Mbr #: ____________
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MONEY REC'D AT TRACK
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SIGNATURE
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It is understood and agreed that the undersigned and the
car described above are to compete under the General Competition Rules and
these Supplementary Regulations
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Driver___________________________________
Entrant_________________________
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