$50.00 - Registration Fee for 2005

(This is a one-time annual fee for the points series and its payouts only. It allows you to accumulate points at TSM event after the payment is received. Note: You must still pay the event-specific racers’ admission and/or race fee to race at each event.)

(To PRINT, click on this portion of the screen and hit your browser's Print button, or with the mouse pointer within this section, do a right-click and select Print.)

NAME: ____________________________________________

ADDRESS: ____________________________________________

CITY/STATE/ZIP: ____________________________________________

PHONE: ____________________________________________

EMAIL: ____________________________________________

DESCRIPTION of the Turbo Buick or Turbo Buick-powered car that you will be racing:

Year_____ Model_______________ Color____________ Car #:________

(Points are awarded to the driver, not the car. Accordingly, the above info is for the car in which you intend to compete. Car # is your GSCA member # or a 4-digit number of your choice for non-GSCA members.)

We would like to include your name, city, state and the above car info (only) in TSM discussions and the web page. All other details are not made available to any other individuals.

Please indicate your acceptance or denial here: Yes, include my details _____ No, do not include my details _____

PLEASE MAKE CHECK or MONEY ORDER PAYABLE TO: SCOTT SIMPSON (Please note “TSM Registration” on memo space)

MAIL REGISTRATION AND PAYMENT TO: SCOTT SIMPSON - TSM Points Series

654 GAHANNA HIGHLANDS DR.

GAHANNA, OH 43230

You also have the option to register at each event. However, no points will be awarded until your registration is paid in full.

If you do not receive this confirmation prior to your first event, please contact:

Scott Simpson or Lonnie Diers at (614)428-4338 or (937)379-2610