ONLINE TRACK EVENT ENTRY FORM

     Thank you for your interest in the XP Engineering Track Event.  In order to expedite your entrance and reserve your name on the car list, please fill out the form and submit it.  If you are paying via credit card, your application will be accepted upon authorization, and XP Engineering will contact you shortly.  If you are paying by cash or check, you may submit the form online, but you must also print it out and send it, along with payment, to the address below.

XP Engineering
2464A N. Glassell
Orange, CA 92865
Tel: 714.921.3269  Fax: 714.921.3270

HOLTVILLE TRACK EVENT - MAY 20, 2001

Driver's Name:

Address:

City:

   State:    Zip Code: 

Email Address:

Phone Number:

(home)

   (work) 

(mobile)

Person to contact
in case of emergency

   Phone  

Vehicle Make:     Model:    Year: 

Sandwich Choice:          BLT   Ham   Turkey   Cheese

Chip Choice:              Regular   BBQ   Fritos     Cheetos

Drink Choice:                        Coke     Sprite

Package     Method 

Card Number     Expires Month   Year         

*Make Checks payable to XP Engineering

I know and understand that:

High speed driving is dangerous (initial here)

Even though there are event and track rules and procedures in place, an accident could happen that could cause injury or death.

I am prepared to pay my own medical expenses.
I am aware that this event has no medical or liability insurance.

I am voluntarily participating in this activity with the knowledge of the danger involved and hereby agree to accept any and all risks of personal injury, property damage or death.


Signature: 

By printing your name and submitting this form, you are acknowledging all of the above