ANNUAL CONGRESS

ICMS RACE TRACK SAFETY PROGRAM (RTSP) REGISTRATION

SECTION 1: Registration Information

Registration for the Race Track Safety Program (RTSP) MUST be made through the ICMS office only.

You cannot register for the RTSP through the PRI Trade Show website.
Please fill out all the fields, accept terms and hit the send button.
* Required

Last Name: *	SUFFIX/DEGREE:
First Name: *	Middle Initial:
Motorsports Affiliation: *
Address: *
City: *	State/Province: *
Postal Code: *	Country: *
Telephone: (ICMS use only) *	CellHomeOffice
Email Address: *

SECTION 2: Registration Categories

Please select the appropriate registration category and then using the drop down menu select your occupation. If your occupation is not listed, complete the “Other” section.

Pre-Registration

(Select before November 30)
Registration Fee $75.00

Onsite Registration

(Select after December 1)
Registration Fee $100.00

Occupation

SECTION 3: Payment Instructions

Please select your form of payment: Check (complete section 3A)Credit Card (complete section 3B)

SECTION 3A: Check Payment (skip this section if paying with a credit card)

You can pay with a Personal Check or Corporate Check. Make sure your full name is on the memo section. If the check payment is for more than one registration, please complete and submit an online registration for each person. Once the online registration(s) is submitted you will receive an email confirmation. Please print the email(s) and mail it with your check to: The ICMS, 9305 Crestview Drive, Denton, Texas 76207.

SECTION 3B: Credit Card Payment (skip this section if paying by check)

For credit card payments provide ALL the information requested in the section below. Please note all credit card information is destroyed once payment is processed. This procedure is for your protection and credit card security.

Name: (As it appears on the card)
Credit Card: MasterCardVisaDiscoverAmExOther

Expiration Date:

Month:

Year:

Card Number:	SECURITY CODE: (3 or 4 numbers on back or front of your card):
Billing Address: (for this credit card)

POSTAL CODE: (for this credit card)

I AUTHORIZE ICMS TO CHARGE THE FOLLOWING AMOUNT TO THE CREDIT CARD STATED ABOVE: $

You will receive an email from the International Council of Motorsport Sciences through Intuit Business Services (BusinessServices@Intuit.com) when we process your credit card information to let you know your transaction has been completed. This email receipt will include the amount, the cardholder’s name, card type, date & time and a transaction ID number. Please retain this receipt for your records. The receipt of payment will be itemized on your credit card billing statement following the transaction.

SECTION 4: Submitting Registration Information

To submit your registration form for the Race Track Safety Program check the box below and hit the “send” button.

If you have any questions regarding registration or this information, please contact Don Andrews, the ICMS Executive Director at +1 (940) 262-3481 or by email at donandrews@theicms.org.

Submitting your registration confirms and acknowledges that you have reviewed and verified the accuracy of your registration information.