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Phil
Wicks Ultimate Mini Driving Academy
2004 Driving Year Entry Form
Please print
this form, fill it in, and mail it to the address below.
Payment in full must
be received two weeks prior to event.
NEW! Pay by VISA
or MASTERCARD!
For more information,
please call (615) 354-5576
Please print clearly:
Participant Name:____________________________________________
Event Date: ___________ Location/Track: _________________________
Driving Group
(circle one): Novice
Intermediate
Expert
Car Year, Make
and Model: _____________________________________
Address ____________________________________________________
City, State, Zip _______________________________________________
Phone Number(s)
Home_______________Work_______________Cell________________
Email Address:______________________________________________
Emergency Contact: Name______________________Phone__________
Fee: $________ (varies by event, please see Schedule for fees and discounts)
Mini/MINI Club
affiliation: ________________________________________
Payment Method:
Visa / MC Card
No. _____________________________ Exp.
date: _____
Signature: ___________________
Name on card: ___________________
Cashier’s Check _____ Money Order _____ Personal Check ____
Print this form, add your information and mail it with your payment
to:
Phil Wicks Driving Academies
Ultimate MINI Driving
Academy
1012 Davidson Road
Nashville, TN 37205
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