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
[email protected] 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