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