Registration Form Keep this field blank: >> On-line payment is made after "SUBMIT EVENT REGISTRATION" is clicked, with all major credit cards or PayPal << About You First Name*: Required field Last Name*: Required field E-Mail*: Required field Phone*: Required field Address*: Required field City*: Required field Prov/State*: Required field Postal Code*: Required field Your Objectives: Previous Driving Courses*: Required field Skill Level*: NoviceIntermediateAdvanced Required field Your Vehicle Year/Make/Model*: Required field Car Colour*: Required field License plate*: Required field Modifications: Event Selection High Performance Driving School $300 + HST Advanced / Racer Development $400 + HST Race Academy $525 + HST September 18, 2017 01 01 01 October 1, 2017 01 01 01 October 21, 2017 01 01 01 Registration price: $ Information and Privacy Policy The purpose for collecting a driver’s and payee’s information is to allow Shannonville Motorsport Park Driving Academy (Organizer) to conduct the Brack Driving Concepts Programs effectively. The primary uses are to enrol and classify a driver as a participant; secondary uses are for the Organizer’s insurance and liability protection (as applicable). Except to the Organizer’s insurance and legal representatives and regulatory bodies where necessary, or where permitted by privacy legislation, neither the Organizer nor Brack Driving Concepts will disclose personal information to third parties without your consent. Unless directed otherwise in writing the Organizer or Brack Driving Concepts may advise you of future driving events using the contact information provided. By submitting this form I consent: to the use and disclosure of this information in accordance with the Privacy Statement; to you obtaining a report from any schools I listed as having previously attended, as to my attendance/performance at them. I also authorize the use of any testimonial, picture taken of myself and/or my vehicle while participating in a Brack Driving Concepts Program, for promotional purposes, without restriction by the Organizer or Brack Driving Concepts. Driver and guests under age 19 are required to complete additional waivers. Email info@brackdriving.com for waiver forms. Please fill in the code displayed here:
