You MUST agree to the 3 questions at the end of the form for your application to be processed.
Please provide the following contact information.
First Name
Last Name
Car Number
Button Down Shirt Size Small Medium Large XL XXL XXXL
Jacket Size Small Medium Large XL XXL XXXL
Driver Entry Fee - $695
Food Selection: Please choose from 1 of the 2 duets for dinner
A. Flat Iron Steak and Seared Chicken both marinated with a chasseur sauce
B. Chicken Breast and Salmon both grilled with a red current demi glaze
C. Kids Meal: Spaghetti and Meatballs
Guest Food Package: Are available in 1 of 2 options
Option #1 Full food package with a reception and banquet $125
Option #2 Banquet only Saturday pm $75
Please dress smart for the Saturday night banquet! Jackets are not required!
Will you be bringing any guests?
If so how many @ $125
How many guests for the Saturday night banquet only @ $75
Name of Guest
Will you be attending the Friday Test and Tune?
Full day 8:30-5:30 @ $425 (No lunch) Yes or No
Half Day 1-5:30 @ $325 (No lunch) Yes or No
Car Class Unlimited Comp Coupe Super Mod Modified Prep Super Stock Stock Neon
PDS 4 PDS 6 PDS 8
Payment
Your form and payment must be received by October 6! Viper Days accepts Visa, Master Card, American Express, Discover or Check (prior to the event)
If paying by credit card please enter a phone number you can be contacted
For your security we will voice verify all credit card payments.
If paying by mailing a check, please list the check number
You MUST select each of the following:
I agree that I have read and will comply with VRL Rules
I agree that I have read the VRL Release and Agree
I agree I have signed up for VRL and I will pay for the event.
If you agree to all the rules and have checked all 3 boxes above, type YES in the box below.
Type YES in the box in all capital letters.