Ultimate Short Track Experience Enrollment Form
Phone: 816-254-RACE Fax: 816-230-8222
NAME: _______________________________ ADDRESS: ________________________________
CITY: _________________________ STATE: _____________ ZIP: _______________________
HM PHONE: ______________ WK PHONE: ______________ E-MAIL ______________________

If purchasing as a gift certificate please complete the following information:
NAME: _______________________________ ADDRESS: ________________________________
CITY: _________________________ STATE: _____________ ZIP: _______________________
HM PHONE: ______________ WK PHONE: ______________ E-MAIL ______________________

For gift certificates, only indicate the course number you are purchasing. Do not choose a date, leave open for recipient to choose. We cannot schedule dates for gift certificates. Do you want the gift certificate sent to: purchasers' address or recipients' address (please circle one)?

Indicate which course you are enrolling in and the date you would like to attend:

Program 1	5 lap	Riding Experience	$49.95	I understand that the course dates are on a first come, first serve basis. Programs 1, 2, and 3 must be paid in full in advance, but courses 4, 5, 6, 7, 8 and 9 may be reserved with a 50% deposit and the balance paid before the class. Program # ________ Date Choice ___________ * Taken in 12 lap increments
Program 2	10 lap	Riding Experience	$99
Program 3	5 lap	Driving School	$100
Program 4	10 lap	Driving School	$199
Program 5	16 lap	Driving School	$320
Program 6	*24 lap	Driving School	$480
Program 7	*36 lap	Driving School	$720
Program 8	*48 lap	Driving School	$960
Program 9	*60 lap	Driving School	$1200

PAYMENT INFORMATION:
I am enclosing $___________(check/money order) Or, Please charge my credit card in the amount of $__________
_____Visa _______ MC Card #__________________________________________Exp_______
Cardholder's name_____________________________Signature_____________________________
Comments/Code Word____________________________________
Before completing your order, you must read and agree to the following:
All Ultimate Short Track Experience enrollments are valid for twelve months from issue date. All cancellations must be made 30 days prior to your scheduled School date, in order to retain full credit for course fees paid. Cancellations made less than 30 days prior to the scheduled school date or failure to attend will result in the loss of your entire course fee. The class schedule is subject to change due to scheduling or weather conditions. All Schools cancelled, for any reason, must be rescheduled and used by the student before the Certificate's 1-year expiration date. Students in a Rain-Out School will received a 6-month extension from the date of the rained-out school.

Please enclose this form with check or money order to the address as follows:

Ultimate Short Track Experience	Phone:(816) 254-RACE
12773 N. Outer Rd	Fax:(816) 230-8222
Odessa, MO 64076	www.ultimateshorttrackexperience.com