2025 Corvette Club of Iowa Low- Speed Autocross Events 1901 Bell Ave, Des Moines, IA 50315 September 27-28, 2025 Autocross Event Form 2025How many Drivers? One Driver Two DriversDriver #1 InformationDriver #1 First NameDriver #1 Last NameDriver #1 Mobile NumberDriver #1 EmailDriver #1 AddressAddress Line 1Address Line 2CityState9-Digit Zip CodeIs Driver #1 an NCCC Member? Yes NoDriver #1 NCCC #Driver #1 Permanent Number (if applicable)Driver #2 InformationDriver #2 First NameDriver #2 Last NameDriver #2 Mobile NumberDriver #2 EmailDriver #2 AddressAddress Line 1Address Line 2CityState9-Digit Zip CodeIs Driver #2 an NCCC Member? Yes NoDriver #2 NCCC #Driver #2 Permanent Number (if applicable)Emergency ContactPlease indicate who to contact in case of an emergencyFirst NameLast NameRelationMobile NumberCar InformationYear of CarModelNCCC Class - NCCC RulebookPlease list any modifications that may affect your car's classificationEvent SelectionFill out the section below for either a one day with 7-Events or 14-Events across two days.Driver #1 Race Day Selections Saturday, September 27 - Driver #1, Member Sunday, September 28 - Driver #1, Member Saturday & Sunday, September 27-28 - Driver #1, MemberDriver #1 Race Day Selections Saturday, September 27 - Driver #1, Non-Member Sunday, September 28 - Driver #1, Non-Member Saturday & Sunday, September 27-28 - Driver #1, Non-MemberDriver #2 Race Day Selections Saturday, September 27 - Driver #2, Member Sunday, September 28 - Driver #2, Member Saturday & Sunday, September 27-28 - Driver #2, MemberDriver #2 Race Day Selections Saturday, September 27 - Driver #2, Non-Member Sunday, September 28 - Driver #2, Non-Member Saturday & Sunday, September 27-28 - Driver #2, Non-Member By checking this box, I understand 1. All entrants MUST completely and truthfully fill out this registration form. All entrants eighteen (18) years and older MUST also sign the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT and any other release documents which maybe required by NCCC. Entrants younger than eighteen (18) years old must have a parent or legal guardian present and submit a properly completed PARENTAL CONSENT, RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT and a MINOR'S ASSUMPTION OF RISK ACKNOWLEDGMENT and any other release documents which may be required by NCCC. 2. All drivers MUST be properly licensed per Section 1.7.1 (Eligibility to Compete) of the NCCC Rulebook.Online Processing FeeIn order to keep the costs low for our non-profit club, a processing fee of 2.9% + 30 cents will be applied to all online payment transactions.Subtotal$Processing Fee$No payment items has been selected yetPay Now - -