Registration Form / Race Certification Bundle Javascript is required for this form to work properly * Required 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 Your Vehicle Year/Make/Model*: Required field Car Colour*: Required field License plate*: Required field Modifications: Save with Interac e-Transfer! Pick your pricing and payment method - save with Interac e-Transfer! Interac e-Transfer or Credit Card / PayPal Temporarily unavailable Event Selection Pay with Interac e-Transfer Pay with PayPal Race Certification Bundle Classroom and Race Procedure Program to be held on mutually convenient days $1,050.00 + HST01 $1,010.00 + HST01 Registration price: + 13% HST Information and Privacy Policy The purpose for collecting driver and payee information is to allow us to conduct the Brack Driving Concepts (Organizer) programs effectively. The primary uses are to enrol and classify a driver as a participant; secondary uses are for insurance and liability purposes (as applicable). Except to insurance and legal representatives, regulatory bodies where necessary, or where permitted by privacy legislation, the Organizer will not disclose personal information to third parties without your consent. Unless directed otherwise in writing the Organizer may advise you of future driving events using the contact information provided. By submitting our application form I consent: to the use and disclosure of this information in accordance with the Privacy Statement; to you obtaining a report from any driving 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. Drivers under 19: Drivers under age 19 are required to have additional waivers completed with their parent/guardian, one of whom has to be at the event. Email info@brackdriving.com for appropriate waiver forms. Please fill in the code displayed here: Required field
