2011 Midwest Region Championship Series Saturday, October 1, 2011 and Sunday, October 2, 2011

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1 2011 Midwest Region Championship Series Saturday, October 1, 2011 and Sunday, October 2, 2011 ** Qualified Members Only, by Invitation ** Host Club: Sunburst Corvette Club, MW-277, Crystal Lake, IL Location: Concours and Rallye Reichert Chevrolet, 2145 S Eastwood Dr, Woodstock, IL Location: Autocross Affinia, Receiving Parking Lot, 1302 Miller Parkway, McHenry, IL, Event Fees: $20.00 per event (Rallye and Concours per car, Autocross per driver) Event Details Entrants may be asked to work the event Drivers must have a valid driver s license and NCCC card for registration Entrants must have an address for results distribution ALL EVENTS ARE CLOSED EXHAUSTS All times are Central Daylight Saving Time Saturday, October 1, 2011 Sunday, October 2, 2011 Concours Registration / Tech: 9:30AM 10:00AM Autocross Registration / Tech: 8:30AM 9:30AM Stop Clean: 10:30AM, Drivers Meeting: 10:35AM Drivers Meeting: 9:45AM Judging begins after Drivers Meeting 1 st Car on course after Drivers Meeting Rallye Registration / Tech: 1:00PM 1:30PM Drivers Meeting: 1:35PM 1 st Car out after Drivers Meeting Lodging Info Track Info The Hampton Inn No lunch available 1555 South Route 31, McHenry, IL Alcoholic beverages not allowed Phone Fast food restaurants nearby Rooms $ 89/night NO pets allowed Reserved under Sunburst Corvette Club Sunburst Governor Chairpersons Matt Waters Overall Coordinator Karen Hottenrott Concours & Rallye Phone: JR Hottenrott Autocross mrwaters@ .com Phone: mwrcs2011@wi.rr.com

2 2011 MIDWEST REGION CHAMPIONSHIP SERIES, Oct 1-2 ***PRE-REGISTRATION REQUIRED*** Please return this pre-registration form allowing enough time for it to be received no later than September 27, Please note that all entrants must be pre-registered and all events must be pre-paid. The class you are entering must be declared on the pre-registration form. There is no day of registration. Only those Qualified and Invited may enter the MWRCS events for PLEASE PRINT YOUR TELEPHONE NUMBER, in case we have any questions YOUR ADDRESS, for results distribution If you have any questions, please refer to the contact information on the MWRCS flyer MWRCS CONCOURS NAME: NCCC #: MW- NAME: NCCC #: MW- CLASS ENTERED: $20.00 per CAR $ MWRCS RALLYE DRIVER NAME: NCCC #: MW- NAVIGATOR NAME: NCCC #: MW- $20.00 per CAR $ MWRCS LOW SPEED - Every autocross entrant MUST sign and return, with registration, the enclosed site waiver. DRIVER #1: NCCC #: MW- CLASS ENTERED: RESERVED CAR # $20.00 per DRIVER $ DRIVER #2: NCCC #: MW- CLASS ENTERED: RESERVED CAR # $20.00 per DRIVER $ MWR Permanent Number List applies and takes precedence. Request for use of non-reserved car number: DRIVER #1: 1st choice: 2nd choice: $10 per number $ DRIVER #2: 1st choice: 2nd choice: $10 per number $ TOTAL ENCLOSED: $ MAKE YOUR CHECK PAYABLE TO MIDWEST REGION AND MAIL WITH THIS REGISTRATION FORM TO: Karen Hottenrott ~ MWRCS Registration ~ W703 Miller Road ~ Burlington, WI SATURDAY EVENING GET-TOGETHER Information to come in future , ~6:00pm: we need an approximate count of people for the restaurant. You will be advised if your reservation exceeds the legal limit for the facility. Number of people Clothing awards: Please complete the section below for each entrant. Print your name exactly as you would like it to appear on the award. Circle the desired size. For Shirts, circle both the desired cut (mens or ladies), and the size. NAME: NAME: JACKET: S M L XL 2X 3X JACKET: S M L XL 2X 3X SHIRT: MENS LADIES MENS LADIES S M L XL 2X 3X SHIRT: CUT CUT CUT CUT S M L XL 2X 3X Office Use Only: Postmark Date: Date Received: Check # Total of Check: $

3 2011 Midwest Region Championship Series Maps and Directions The Hampton Inn is located north on IL Route 31 between Crystal Lake and McHenry. To get to Affinia, just north of The Hampton Inn, turn west on Prime Parkway. Follow the parkway to the end and turn right on Miller Parkway. Continue to the Affinia Receiving Lot. Reichert Chevrolet is located in Woodstock, on Route 47. From Crystal Lake, take Route 14, Northwest Highway, north to Woodstock and turn left on Route 47. If you don t trust your GPS or Yahoo - drop me a line for detailed directions: mwrcs2011@wi.rr.com

4 Auto Racing Waiver and Release I wish to participate in the Corvette Autocross car racing event (the event ). I understand that while participating in this event, I will be using transportation and facilities where many hazards exist and I am aware of and appreciate the risks that may result. I am also aware that accidents may occur during this event which may result in serious injury or death. I am voluntarily participating in this event with knowledge of the dangers involved and I will accept all risks of injury or death. In consideration for being permitted to participate in this event, I will assume all risks and release, hold harmless, and covenant not to sue Affinia Group Inc. (and its subsidiaries and affiliates), Manulife Financial Corporation and its wholly owned subsidiary, John Hancock Life Insurance Company (U.S.A.), or any designated sponsors, officials, participating clubs, communities, organizations, friends of the event, including the event staff and crew, and all other persons or entities including, but not limited to, the affiliated organizations and all their respective directors, officers, agents, employees and members (collectively, "the Releasees") for any claim, loss or liability that I may have arising directly or indirectly out of my participation in the event, including bodily injury, death or property damage whether caused by negligence or carelessness of the Releasees or otherwise. I intend by this Waiver and Release to release, in advance, and to waive my rights and to discharge all of the Releasees from all claims, loss or liabilities for death, bodily injury, pain, suffering, property damage, loss of income or any other claim, loss or liabilities that I may have, or which may hereafter accrue to me or my heirs, assigns and legal representatives, as a result of my participation in this event, even though that liability may arise from negligence or carelessness on the part of the Releasees, from dangerous or defective property or equipment owned, maintained or controlled by them or because of their possible liability without fault. I understand and agree that this Waiver and Release is binding on my heirs, assigns and legal representatives. I verify that I am physically fit and that my physical condition has been, or will be, verified (prior to the event) by a licensed medical practitioner. If I am a participant, I verify that I have, or will, train sufficiently to participate in the event. If, however, as a result of my participation in the event, I require medical attention, I give my consent to the authorized medical personnel of the event to provide such medical care as is deemed necessary by such authorized personnel. I also understand that I will be financially responsible for the costs of any medical treatment. I verify that I have adequate medical insurance or will have such insurance at the time of the event. I will read the event description and rules for participation in the event and I will abide by all rules and regulations established by the event organizers and personnel as well as state and federal laws and local codes. I agree to be properly fitted for the event at all times. I further agree that my participation in the event is subject to the sole discretion of the organizers of the event, and that my participation may be limited for medical or other safety-related reasons. I certify that I am at least 18 years or older and have a valid driver s license to drive on the date the event commences. Initial I agree that my name, photograph, voice or likeness may be used by any of the Releasees, and their sponsors, licensees, affiliates and volunteers and staff. I consent to and authorize, in advance, such use and waive all rights of privacy I have in connection therewith, and I understand that I will not benefit financially from any use thereof. I have carefully read this Waiver and Release and fully understand its contents. I am aware that by signing this Waiver and Release, I am waiving legal rights and knowing this, I sign it of my own free will. I agree I decline Signature Date Print Name:

5 Championship Series Tee Shirt Order Form Color: Pistachio with black logo shown above on the left chest Name: Quantity: Size: S M L XL 2XL 3XL Cost: $12; 2XL/3XL: $ Total: Name: Quantity: Size: S M L XL 2XL 3XL Cost: $ 12; 2XL/3XL: $ Total: Please make a separate check payable to Sunburst Corvette Club. If there aren t enough shirts ordered to make the minimum order, your check will be returned. Note that the 2011 MWRCS shirts are available through pre-order only.