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2012 REGISTRATION

2012 TEEN MAZDA CHALLENGE REGISTRATION FORM 1. First name:________________________ 2. Last name:______________________________________ 3. Mailing Address: (number & street )______________________________________ (city)________________________________________________ (state) ___________ (Zip code): _________________________ 4. Email address:_____________________________________________________ 5. Telephone number: _________________________________________________ (optional number) __________________________________ 6. Date of Birth* _______ /_____ / 19_______ * You must be over 13 years of age and under 23 years of age the day prior to your first Teen Mazda Challenge points paying race to be eligible. 7. Past racing experience: Go Karts, Motocross, etc. ____________________________________________________________________ ____________________________________________________________________ 8. Additional sports you've played: __________________________________________ 9. School attending (optional):_____________________________________________ 10. Include a picture of your face (head shot) see driver page for an example. 11. Include a picture of your NASA Spec Miata Race Car. 12. 2012 Registration fee** $75.00 ** Registration fee is required to participate in the 2012 Teen Mazda Challenge. Check's should be made out to A.I.M. Or MasterCard, Discover and VISA credit cards are accepted. Particpants will receive free promotional items from Teen Mazda Challenge throughout the season. FORWARD THE COMPELETED FORM to the mailing or email address listed on the left side of this page Questions: 800-578-2071. email: teenmazda@gmail.com A completed registration form and fee is required before any TMC points can be awarded. SO PLEASE SEND THE FORM IN TODAY! You must hold a current NASA Competition license and a current Minor Release must be on file with NASA (National Association of Sportscar Racing)

TEEN MAZDA CHALLENGER COMPETITOR REGISTRATION FORM Please fill out this registration form and send it via one of these methods: 1) E mail: teenmazda@gmail.com 2) Fax to: 707-938-9564 3) Snail Mail to: TEEN MAZDA CHALLENGE c/o A.I.M. 29651 Arnold Dr. K-7A Sonoma, CA. 965476

http://www.nasaproracing.com/norcal/event/minor-waiver.pdf 






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