CSCC Registration Form

Date:________

Name:___________________________ Phone #:_________________

Drivers Lic #_____________________ Insurance Co._____________

Notify in Emergency ______________ Their phone: _____________

At site? Yes / No

Your address:_________________________________________________________

Car#_________________________________________________________ Car Class:_______________

Color:____________________ Year & Model:___________

Driver’s License verified _______________________________________

(Registrar’s signature)

Amount Paid $______________ Waiver Signed__________________

Fees: $25.00 members $30.00 non-members (Registrar’s signature)

Annual club fees$20 per year ($15 additional for driving spouse) . Join now and save.

(TEAR HERE)

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Tech Inspection Form

Name: ____________________ Car#________________

Place this form on windshield. Class__________________

Bring car to tech. Open hood & trunk. Color ___________________

Place helmet on driver’s seat Year & Model _________

Tech Inspector to check the following:

Battery ____________ Numbers__________

Helmet _____________ Fluids ____________

Throttle ____________ Hubcaps__________

Brakes_____________ Loose Items _______

Tires & Lug Nuts _____ (removed)

Inspected by:______________________________________________________