Driver Education Day Registration Form


 

PLEASE NOTE
Due to a change of web servers by PCA,
which the Polar region relies upon,
the following form no longer functions.
This falls outside the control of Polar region.

To register for the 2010 Driver Education event,
please complete the form below, then either
print and fax or scan and email the completed form
directly to Michael Stevenson (see »below).

 


Primary Driver/Owner Information:
Primary Driver:  
Address:  
City:  
Province:  
Postal Code:  
Phone:  
Fax:  
Email:  
Primary driver's
experience level:  		 Novice:  have not participated in a driver education track event.
Intermediate:  have participated in a driver education track event but not with this car, or not at this facility.
Experienced:  have participated in a driver education track event at this facility with this car.

Vehicle Information:
Year:  
Model:  
Color:  
Inspection:   By checking this box, I signify I am aware that all participant vehicles must be inspected by a licensed mechanic prior to the event, and that should I arrive at the event without proper documentation of inspection and brake fluid age, I will be turned away from the event without a refund.

Additional Driver:
Name:  
Additional driver's
experience level:  		 Novice:  has not participated in a driver education track event
Intermediate:  has participated in a driver education track event but not with this car, or not at this facility.
Experienced:  has participated in a driver education track event at this facility with this car.

Accommodations:
Room (night    before school):  
Share room with:  


Fees & Payment Details:
Car & First Driver:     1      @ $295.00
Additional drivers:   @ $250.00 each
Non drivers (lunch only):   @ $35.00 each
Payment Method:  
Cardholder Name:  
Card Number:  
Expiry Date:  


Additional Comments:


Cancellation Policy:

Refunds are at the discretion of the registrar, if notification is received fourteen (14) days prior to the event, and if your spot can be filled from the waiting list.


Please send completed registration form to 
Michael Stevenson
by fax at 780-437-5446, 
or by email at mstevenson at porscon dot com.

 

 


Page last updated: February 03, 2010
© 2004 PCA Polar Region and Webmaster Paul Conquest.  All images and content reserved.