Billy Pauch Racing School - Enrollment Form

Billy Pauch Racing School
611 Highway 519, Frenchtown, NJ 08825, (908) 996-6236 or (908) 996-7288.
2008 ENROLLMENT FORM

Name __________________________ Day Phone(____) ____________ Evening (____) ____________
Address _____________________________________________________________________________
City _____________________________________ State _______________ ZIP Code ______________
Occupation _______________________________ Age ______ Drivers License # _________________
Where did you hear about the school? ____________________________________________________
Prior racing experience (not necessary to enroll) ____________________________________________
Do you have any health problems which may endanger your life or others while taking this class,
such as, but not limited to, color blindness, heart condition, high blood pressure, seizures,
dizziness, diabetes, prescription drugs, etc.? Yes ____ No ____
If the answer to any of the above is yes, please provide physician's letter of approval to take this course.
In case of emergency, notify: Name _________________________ Phone (____) ________________
Please indicate desired course, with dates and Speedways requested, 1st choice and 2nd choice. (Prices are for 2008 courses only.)
Select car: _____ Class Modified _____ Class Sprint
Full Payment Must Be Received to Confirm Enrollment

Course	Cost	New Egypt	Grandview	Type of Race Car
1 Day Class Using class car - full day	$675
1 Day Class Using own car	$300
1 Day Class (20 laps, class car)	$475
Ride Along	$100			Class Two-Seater

Cancellation Policy- Sorry, No Exceptions
I understand that a 15% administrative fee (based on course cost) will be assessed on all cancellations. Any cancellation with less than 30 days notice shall forfeit 30% of course cost. Any cancellation with less than 14 days notice shall forfeit 50% of course cost. "No shows" forfeit entire course cost.
I also understand that no refunds will be made on cancellations with less than 5 days notice, but that the balance, if any, (after cancellation fee) may be applied the next 3 scheduled schools.

Enclosed is a check payable to Billy Pauch in the Full Amount of $__________
Charge VISA or Mastercard #____________________________ Exp. ________

I have read the Cancellation Policy and understand that any damages done to the class car being used is the student's responsibility. I understand that a binder of $500.00 is due the day of track practice. The binder is used for damages to the class car. Any damages that exceed the binder are the responsibility of the student.

Signature ___________________________________________ Date ____________________