2012 EDMONTON INDY

Racing Services Group
Racetrack Worker Registration Form

EDMONTON : July 20, 21 & 22 — 2012
Friday, Saturday & Sunday
Please complete this form accurately.
And please forward this address to a friend. (or TEN.)
We can always use MORE PEOPLE to effectively run this event. (Thanks!)
* denotes required field
First Name:*

     Last Name:*
    
Address:*

    Town:*
   
    Prov./State:*
    		   Postal Code:*
   
    Country:*
   
Phone:*
()
   Cellphone:
   ()
   Email Address:*
   

LOCAL phone number: (If you're from out of town)   
()
Date of Birth:*
Month
   Day
   
   Year
   
   T-Shirt size:
   
Emergency Contact:*

    Best phone number to reach this contact:*
   ()
   Is this contact on site? *
   
Drug Allergies:
    Medical Conditions we should know about:
    		   Medications:
    		   Blood Type:
   

Racetrack specialty: (In what capacity would you prefer to work?)
    Club Affiliation:
    		   Will you need a parking pass?
   

  EXPERIENCE: (Approximate numbers are OK)
  Total Number of Race Events worked:    Number of Race Events worked in:    2012   2011   2010

  Total Number of CART/ChampCar/IndyCar Events worked:

  REFERENCES:   

THANK YOU for your patience in filling out this form.

Racing Services Group is collecting this information to assist in the operation of the Edmonton Indy. This information may also be used to contact individuals regarding motorsport training, and about other local motorsport events. This information will not be sold or traded. Racing Services Group makes every reasonable effort to safeguard the privacy of their valued volunteers and to be compliant with the 'Alberta Personal Information Protection Act'.
   

NOTE: If you do not recieve a reply within one week, please check your "junk" email.
If there's still nothing, please mail Rudy directly: Rudy@vanwoerkom.net