Individual Registration

Please enter information in the form below to process registration for event Two Day - SCCA Accredited.

Classroom safety sessions must be ATTENDED or participant may not be permitted on course.

REFUND requests submitted in writing sixteen (16) or more days before your scheduled course will be refunded less a $250.00 service charge. No refunds, no credits and no rescheduling within sixteen (16) days of your scheduled course. NO EXCEPTIONS. No refunds or credit will be issued wherein the participant is deemed to be a "NO SHOW". All courses will be held regardless of WEATHER CONDITIONS. If, in the interest of safety, it is cancelled, you will be notified by phone.

All students under the AGE of 18 must have a signed Minor Release Form on file to participate in any drive event.

First Name *

Last Name *

Organization

Address *

City *

Zip *

Country *

State *

Phone *

Email *

Comment

Cell Phone *

Drivers Age *

How did you hear about FASTLANE? *

Medical Conditions *

Please tell us what Level of a driver you are. *

If driving your own car - Make / Model / Year Copy *

Private Instructor *

Add a Gift Certificate *

Lunch (sandwich, chips, cookie & soda) *

Payment Information

Amount

Discount Amount

Gross amount

Coupon

Payment Method *

Credit Card - AmX / MC / Visa Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

iDeal Bank*

By registering for this course, I accept Terms and Conditions

Individual Registration

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