Coker Tire Challenge » 2012 Challenge Registration

2012 Challenge Registration – Sept 13-16

I WOULD LIKE TO ENTER

(Dash for Cash Money goes to a separate prize fund and is determined by the number of the DFC participants)

Run for FunDash for CashRookie / $300.00 Rookie / $100 ($400 Total Entry) Veteran / $550.00 Veteran / $250.00 ($800 Total Entry)

PARTICIPANTS

(Please send duplicate form for additional teammates)

Driver

Address

Telephone

Email Address (required)

T-Shirt Size

Navigator

Address

Telephone

Email Address (required)

T-Shirt Size

CAR

(Classic Cars / Specialty Vehicles / Rental Cars)

Will you have a trailer?

Trailer Size

Car Year

Car Make

Car Model

Car Color

Car Number (first choice)

Car Number (second choice)

Car Number (third choice)

PAYEE INFORMATION

Name

Address

City

State

Country

(Make checks payable to Coker Tire Challenge)

YOUR ENTRY FEE INCLUDES

All logistic materials including course instructions, timing controls, full service of the competition and management staff, scoring results and rankings, prizes and awards, and Third-Party Liability Insurance.

Event T-Shirt, event passes, and car decals. Dedicated towing (sweep). Special events, prizes, and awards. End of event celebration. Lots of fun!

HOTEL INFORMATION

Please tell us your preference. The following choices are a representation of what is offered, not necessarily what is still available. This is a first come first serve basis. Contact Crystal Wilson for most up to date availability. telephone: 423-648-8568 / email: crystalw@coker.com

I don't need a room $114 room with 1 Queen + 1 Sleeper Sofa $124 Suite with 1 King Bed $124 Suite with 2 Queen Beds

Do you need a combination of the available rooms?
Let us know.

Check in:

Check out:

MINIMUM VEHICLE INSURANCE REQUIREMENTS

- $250,000 Per Person / $500,00 Per Accident / $100,000 Property Damage OR
- $500,000 Combined Single Limit Policy OR
- Umbrella Liability Policy