PITTSBURGH VINTAGE GRAND PRIX ENTRY REQUEST Schenley Park, Pittsburgh ...

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PITTSBURGH VINTAGE GRAND PRIX ENTRY REQUEST Schenley Park, Pittsburgh, PA July 15 and 16, 2006 * J











PITTSBURGH VINTAGE GRAND PRIX ENTRY REQUEST Schenley Park, Pittsburgh, PA July 15 and 16, 2006
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Submit completed entry by June 1, 2006. (Entry will be returned if incomplete). You must complete a separate entry form for each car you wish to enter.
Enter your pre-war car at no charge when you enter a second car in any other class.

Submit entries to: David L. George, II
c/o D.L. George Coachworks, Ltd.
4029 Glennville Rd. Cochranville, Pa. 19330
E-mail questions to: pvgp@dlgeorgecoachworksltd.com
Driver __________________________________ Address _________________________________

City___________________ State____ Zip______
Entrant/Owner_________________________
Phone (Home) ____________________________
Address________________________________
Phone (Business)__________________________ City________________ State_____ Zip ______ Fax_____________________________________ Phone (Home)___________________________ E-Mail___________________________________ Phone (Business)_________________________ Age _______ VSCCA Comp #_______________
Fax____________________________________
Shirt Size________________________________
E-Mail__________________________________

DRIVER INFORMATION

Current Vintage Racing License_________________________ Issued By____________________ Do you have a current 2006 VSCCA membership? Yes No
Please fill out this section if you do not hold a VSCCA drivers license. Have you completed a recognized competition driving course? Yes No When? __________________ Where? ____________________ Number of Days ________ Do you hold a recognized full competition license? Yes No Number of Years________ SCCA Reg/ Nat ________ IMSA _________ FIA ________ Grade_______ Other ___________
Date of last physical ____________________ Date of last Stress EKG________________________ Do you have any physical or mental problems to prevent your participation? Yes No Have you competed in vintage racing? Yes No

# of Years____________ # of Races________
Have you been black flagged during last 12 months? Yes No Where?_____________________ Why? ____________________________________________________________________________ Have you been involved in an incident at a vintage racing event in which a car was damaged? Yes No

Where? ______________________ When? ____________________
Have you been suspended by any racing organization in the past 5 years? Yes No Organization_______________________________________________________________________

CAR INFORMATION

PLEASE ATTACH A PHOTO OF THE CAR TO ENTRY.

I have a VSCCA logbook for this car and have satisfied the classification committee as to its VSCCA eligibility: Yes No

Chassis No.:_________ VSCCA Class:___________ Colo