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CKG BILLINGS
AMATEUR DRIVING CHAMPIONSHIP SERIES SCHEDULE NOMINATION FORM 2001 |
Please print this form out and send it to the address below, enclosing your payment with the form.
|
Driver's Name:
NickName: |
Shirt/Jacket
Size: (circle one) Ladies: S, M, L Mens: S, M, L, XL, XXL |
| Address: Street/PO Box: |
Type of
Driver License: (circle one) M F Q P A D Other USTA/CTA#: |
| City:
State: ZIP: |
Occupation: Colors: |
| Home Telephone #: Home Fax #: Cell Phone #: e-mail address: |
Business Telephone # : Business Fax #: Date Of Birth: No. Years In Billings: |
NOMINATION FEE: |
$300.00 U.S. Funds (if paid by April 30, 2001) |
| LATE NOMINATION FEE: | $400.00 U.S. Funds (if paid after April 30, 2001) |
| Make checks payable to: | DELVIN MILLER AMATEUR DRIVERS ASSOCIATION |
| Mail to: | Delvin Miller
Amateur Drivers Association P.O. Box 590 240 Main Street Goshen, NY 10924 |