Midwest Region

Memorial Day Fundraiser

Saturday, May 26, 2018 6 Low Speeds MW-391-005~006 MW-315-008

MW-120-001~002 MW-575-004

Sunday, May 27, 2018 6 Low Speeds MW-391-007~008 MW-315-009

MW-120-003~004 MW-522-010

Monday, May 28, 2018 6 Low Speeds MW-391-009~010 MW-315-010

MW-120-005~006 MW-051-001

Location: Rantoul Aviation Center 6 Aviation Center Drive Rantoul, IL 61866

Entry Fees: Pre-Registered: $9/event, $54/day, $162 for all 3 days. See Pre-registration Form on page 2; must be received by May 18, 2018. Day of Event: $11/event, $65/day; or $190 for all 3 days.

Click here for ONLINE REGISTRATION Payment must be received by May 18 to obtain discount.

Saturday Sunday Monday

Registration: 8:00 AM to 9:00 AM 8:00 AM to 8:30 AM 8:00 AM to 8:30 AM

Tech: 8:00 AM to 9:15 AM 8:00 AM to 8:30 AM 8:00 AM to 8:30 AM

Drivers Meeting: 9:30 AM 8:45 AM 8:45 AM

First Car Out: After drivers meeting After drivers meeting After drivers meeting

Chairperson: Ray Bair, Midwest Region RCD

17710 Marti Rd, Mokena, IL 60448-8783

RCD@mwregion.com Cell: 630-400-7493

Event Info:

Drivers must show NCCC Card and valid Driver’s License.

Car numbers assigned by Registration. MWR members requesting numbers other than those assigned will be charged per MWR Rules.

No Alcohol on Premises.

Pets must be on leash.

Overnight RV & trailer parking allowed.

Midwest Region Members will be asked to work.

Closed Exhaust only. 103db Limit.

Passengers allowed per NCCC rules, but 16 years old minimum.

Lodging:

Rooms block reserved at the

First Heritage Inn

217 892-9292

http://heritageinn.magnusonhotels.com/

Super 8—274 243-0200

Midwest Region Fundraiser Registration Form

Mail completed Registration Form and Check Payable to “NCCC - Midwest Region” to:

Karen Hottenrott Pre-registration and payment PO Box 296 must be received by May 18, 2018

East Troy, WI 53120 to qualify for the lower price

ENTRY FEE for 18 event weekend: $190 or $162 (Mailed) 1-DRIVER $380/$324 2-DRIVERS

ENTRY FEE for 6 events May 26 only: $65 or $54 (Mailed) 1-DRIVER $130/$108 2-DRIVERS

ENTRY FEE for 6 events May 27 only: $65 or $54 (Mailed) 1-DRIVER $130/$108 2-DRIVERS

ENTRY FEE for 6 events May 28 only: $65 or $54 (Mailed) 1-DRIVER $130/$108 2-DRIVERS

Driver #1 Name: Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

Driver #2 Name: ____________________________ Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

Driver #3 Name: ____________________________ Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

Driver #4 Name: ____________________________ Registration Use Only> DL □ NCCC # □

NCCC Number: Assigned Number:

E-mail address:

Address, if not as in the NCCC Database.

Street: City: State: Zip Code:

Emergency Contact Information, if not at event:

Name: Relationship: Phone:

Car Information:

Stock Transmission Y N circle answer

Stock Drive Axle Ratio Y N circle answer

For registration use only:

Postmark Date: Date Received: Check # Cash: $

NOTE: All entrants MUST truthfully complete the registration form. All Entrants MUST sign the RELEASE AND WAIVER OF

LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT and any release documents required by NCCC. Entrants

younger than eighteen (18) years must have a parent or legal guardian present and submit a properly completed PAREN-

TAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT and a MINOR’S AS-

SUMPTION OF RISK ACKNOWLEDGMENT; and any release documents required by NCCC. All Entrants MUST show a