KVRG Worker Registration Form

Worker Registration 2005 Season

Workers who are registered with KVRG: You may use this form instead of the yellow sign-up sheet that you receive in the mail. You may also use the Comments section to notify us of changes in your plans (e.g. days you are registered to work and now find you can't).

Others interested in working SCCA events at Heartland Park: please complete this form, indicating what events and specialty you are interested in working. If you are not yet an SCCA member, leave the sections on membership number and region blank. A real person will contact you with information about the event.

Section 1
Name
SCCA Membership no.
E-mail address
Is your information the same as last year? Yes No If 'Yes', you do not need to complete the rest of this section
Address
City, State, ZIP
Phone
Region
Specialty
SCCA Specialty License grade	If none, do you have any previous experience? Yes No

Section 2

Please check each day you would like to work:

April 2/3	Sat Sun
June 4/5	Sat Sun
July 16/17	Sat Sun
Sep 3/4	Sat Sun

Comments

Section 3
T-shirt size S M L XL XXL

Section 4
Emergency Information (optional - if you do not wish to transmit this information via email, you may complete the emergency information form at the track)
Date of birth
Blood type (if known)
Medications
Allergies
Special conditions
Emergency contact
Address
City, State, ZIP
Phone
At track?	Yes No