Membership Application | Challenge Cup Series

Complete your 2021 application on-line using the link below or print the attached PDF and mail in. CCS – 2021 Membership_Form_PDF

2021 Membership Application
Memberhsip info*
- New Member
- Renewal
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact information
Phone*
Email*
Emergency Contacts
Contact #1*
First Last
Contact #1 Phone*
Contact #2*
First Last
Contact #2 Phone*
SCCA/CASC License Information
License number*
Valid thru*
Month
Day
Year
Car Information
Year, Make & Model*
Preferred Car #*
Secondary Car #*
2021 Spotter Guide Image
Accepted file types: jpg, jpeg, png, gif.
Payment $150.00 USD*
- Mail Check
- Pay at track
All check made payable to the Challenge Cup Series. c/o Katrina Carmody 468 E Franklin St, Horseheads, NY 14845
Rules and regulations*
I have read and agree to follow the 2021 CCS General Competition Rules, Regulations, and Technical Specifications.
Signature*
Email
This field is for validation purposes and should be left unchanged.