Automotive Track Day Registration

Page 1) Registration Information

Driver Name*

Club Affiliation (If any)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Emergency Contact Name*

Emergency Contact Phone*

Valid Drivers License*

By checking the box you confirm that you have a current valid drivers license.

Yes, my license is valid

Valid Vehicle Registration*

Your vehicle should be licensed or registered for the street. By checking the box you agree that the vehicle you will be driving is a street type vehicle and not a race car.

Yes, my vehicle is a street car and not a race car

Previous On-Track Experience*

Select the number of track events you have participated in.

None
1-3 events
4-7 events
8 or more events

Group Request*

Select the group that you feel best suites your experience. The track day staff will consider this as they organize the event.

Novice
Intermediate
Advanced

Have you ever been on track at Blackhawk Farms?*

Yes
No

Novices & persons unfamiliar with the track will be assigned an instructor. Would you like an instructor even if you are experienced & familiar with the track?*

Yes
No

Consent*

I affirm that the car entered complies with all safety requirements and that all of the information provided on this entry form is true and correct. I am 18 yrs of age or over.

I agree

Date*

Enter todays date

Thank you for your order!

Automotive Track Day Registration

Step 1 of 2

Page 1) Registration Information

Page 2) Tech Sheet

SELF-CERTIFIED SAFETY CHECK LIST