25th Anniversary Celebration Entry Form

April 10-11, 2010 at Road Atlanta

Complete one entry form for each car/driver pair you are entering.

Select Your Group

Group 1 - SCCA Pro Spec Racer Ford - $1,050*
Group 2 - SCCA Pro Formula Enterprises - $1,050*
Group 3 - USERA Spec Racer Challenge - $750*
Group 4 - Enterprises Sports Racers, Sports Renault, Shelby Can-Am, Re-engined Spec Racers - $750*
Groups 1 & 3 - Both the SCCA Pro and USERA Spec Racer Challenge Races - $1,800*

$100 is non-refundable should you have to cancel for any reason.
*Entry fee includes Commemorative Photo Collection CD.

TEAM INFORMATION

Team Name:	Team Web Site:
Your Name:	Your Title:
Address Line 1:	Address Line 2:
City:	State:	Zipcode:
Your E-mail Address:	Work Phone Number:	Home Phone Number:
Reenter Your E-mail Address:	Cell Phone Number:	Fax Number:
Team Sponsors:	Team History:

VEHICLE INFORMATION

Car Color:	1st Car Number Choice:	2nd Car Number Choice:	3rd Car Number Choice:	Transponder Number:
Chassis Number:		1st Year in Class:	For Group 4 (only), Select Your Car Type: Sports Renault Enterprises Sports Racer Shelby Can-Am Other

TEAM DECLARATIONS

All drivers in Groups 1 and 2 must be current members of SCCA and have an SCCA Pro Racing licence. USERA membership is included at no additional charge as part of your entry fee.

When you provide each team member's e-mail addresses below, we will send them a notice that you have registered for the event.

Entrant:	E-mail Address:
Driver:	E-mail Address:
Crew 1:	E-mail Address:
Crew 2:	E-mail Address:
Crew 3:	E-mail Address:
Crew 4:	E-mail Address:

ACKNOWLEDGEMENT AND DISCLAIMERS

Car numbers will be assigned in the order they are received. Three digit car numbers may be assigned as needed.

Entrant agrees that this entry constitutes an agreement to take part in the EVENT per the USERA Sporting Regulations, Event Supplementary Rules and any posted bulletins for the Event. Entrant agrees to abide by all series and track rules governing the EVENT.

Drivers must have a valid competition license as specified in the SCCA Pro Racing Regulations for Groups 1 and 2, or the USERA Sporting Regulations for Groups 3 and 4.

One entry form is required per car and the Entry is not considered complete until the Entry Fee Payment has been paid. This event is being managed by USERA, Inc. and all checks must be made payable to "USERA, Inc.".

In consideration for being permitted to participate in the Event, Entrant and all Entrant team members agree to permit Event promoters/organizers the use of their name, voice and/or likeness, and images of the team members and team cars, for news, publicity, and feature use including radio, television, internet, motion picture film, newspapers, magazines and any and all other media as deemed prudent to advertise, market and other for the purposes of trade related to the promoters.

A $100 non-refundable processing fee will be retained in the event of withdrawal from the Event for any reason.

ANY PRIZE AWARDS PAID BY USERA WILL BE PAID OR PROVIDED ONLY TO THE ENTRANT DESIGNATED ON THIS EVENT ENTRY FORM. A W-9 (OR W-8) MUST BE ON FILE BEFORE ANY CASH AWARDS CAN BE PAID. ANY PRIZE MONEY OR OTHER AWARDS THAT REMAIN UNCLAIMED NINETY (90) DAYS AFTER THE DATE OF THE EVENT WILL BE FORFEITED.

I have read the acknowledgement and disclaimers above and I FULLY AGREE to their terms and conditions.

By pressing SUBMIT, I acknowledge that I am a representative of the above named team, and hereby register the race vehicle on behalf of the team. If paying by credit card, I authorize USERA, Inc. to charge my event entry fees to the credit card information I will fax to seperately using the Credit Card Authorization Form.