To Register:
 
1. Complete and electronically submit the pre-registration form below at any time. Co-drivers must each submit separate forms. Note that electronic pre-registration DOES NOT guarantee placement in the event.

2. Once you submit the pre-registration form below, you will receive an email which will include the information you entered on the form. PRINT THIS EMAIL, THIS IS YOUR REGISTRATION FORM. Both drivers AND instructors must mail in the registration form.

3. On or after the Registration Opening Date (March 10 for the May event, July 14 for the October event), mail a copy of the Registration Form with a check made payable to “Niagara Region PCA” to:


Curt Hinchcliffe, 5 Black Watch Trail, Fairport, NY 14450

 

Registration forms must be postmarked on or after the Registration Opening Date! Forms postmarked prior to the Opening Date will be returned!

The Registration Fee is waived for the first 50 instructors that mail a registration form on or after the Registration Opening Date.
 
[The information you enter below will be stored on a secure site that can and will only be accessed by the Niagara PCA Registrar.]
First Name:
 
Day Phone:
Last Name:
 
Evening Phone:
Address 1:
 
PCA Region:
Address 2:
 
If Other Region:
City:
 
PCA Member Number:
State:
 
T-Shirt Size:
Zip
 
Check if you are a co-driver:
EMail Address:
 
Co-driver Name:
         
Emergency Contact:
 
Prior DE Days (total):
E. Contact Phone:
 
Prior DE Days (at WGI):
E. Contact Cell Phone:
 
Check if you are an instructor:
Known Allergies:
 
Prior Run Group:
Medications:
 
Vehicle Make:
Blood Type:
 
Vehicle Model:
Physicians Name:
 
Vehicle Year:
Physician Phone:
 
Vehicle Color:
   
Add "Garage Party" guest(s):
 (add $25/guest)