Viper Club of America Presents
Viper Owner Invitational 13 COTA
San Antonio, TX | September 25-28, 2014
REGISTRATION FORM
Personal Information
FIRST Name:LAST NAME
BILLING ADDRESS:
CITY:STATE:ZIP:Country:
Telephone Number:EMAIL:
ARE YOU A MEMBER OF THE VIPER CLUB OF AMERICA? YES
NO
IF YES, PLEASE ENTER YOUR vca MEMBER NUMBER:
GUEST INFORMATION
NAME:
T-SHIRT SIZE:
MEN OR LADIES
NAME:
T-SHIRT SIZE:
MEN OR LADIES
NAME:
T-SHIRT SIZE:
MEN OR LADIES
NAME:
T-SHIRT SIZE:
MEN OR LADIES
VOI13 COTA EVENT PRICING
PAYMENT INFORMATION
CHECK ENCLOSED
VISA
MasterCard
DISCOVER
PAYPAL TO: [email protected] (EVENT FEE ONLY)
ACCOUNT NUMBER:
EXPIRATION DATE:CVV:
VCA venom member
QTY _______
$790/person BEFORE MAY 5th!
$840/PERSON AFTER MAY 5TH
VCA MEMBER
QTY _______
VIPER OWNER/NON-MEMBER
QTY _______
$825/person BEFORE MAY 5th!
$875/PERSON AFTER MAY 5TH
$945/person BEFORE MAY 5th!
$995/PERSON AFTER MAY 5TH
Early Bird
Pricing Until
May 5th!
NAME ON CARD:
SIGNATURE OF CARDHOLDER:
HOTEL INFORMATION | LA CANTERA RESORT
In order to receive the rates offered below, your registration for VOI 13 COTA must first be completed. We will then notify the hotel that you have
registered and you can then contact the hotel and reserve your rooms. Rates are only valid for the nights of September 25, 26 & 27, 2014.
STANDARD/DELUXE
$169/NIGHT
ROOM QTY
DOUBLE
KING
CHECK IN DATE:
EXECUTIVE CLUB
$189/NIGHT
ROOM QTY
DOUBLE
KING
CHECK IN DATE:
CHECK OUT DATE:
JUNIOR SUITE
$209/NIGHT
ROOM QTY
DOUBLE
KING
CHECK IN DATE:
CHECK OUT DATE:
CASITA$229/NIGHT
ROOM QTY DOUBLE
KING
CHECK IN DATE:
CHECK OUT DATE:
CASITA SUITE
EXECUTIVE SUITE
CHECK OUT DATE:
$249/NIGHT
ROOM QTY
DOUBLE
KING
CHECK IN DATE:
CHECK OUT DATE:
$499/NIGHT
ROOM QTY
DOUBLE
KING
CHECK IN DATE:
CHECK OUT DATE:
Check out this BEAUTIFUL 5-star resort online at: www.resortlacantera.com
FAX, mail or email your completed registration form to:
The Circuita “kick
Viper Club of America | Angela M Montgomery | [email protected]
as (
of the Amernicown Formula 1
Fax: (972) 490-4219 | Phone: (972) 233-9107 ext. 221 | Toll Free: (800) 677-4321
e
14070 Proton Road, Suite# 100, Dallas, TX 75244
asp” worldTrhe La Cantera Resort
+
*Please
note
that
payments made to VCA are not tax deductible.
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race track tar luxur y resort) /
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ALL EVENT REGISTRATION IS FINAL - NO REFUNDS!
ighway =
TRANSFERS ON EVENT REGISTRATION ALLOWED UNTIL SEPTEMBER 8, 2014 FOR A SMALL FEE.
an 85 mph Sh ST YLE!
VOI TEXA
Space is limited, don’t miss this opportunity to reserve your spot at VOI 13 COTA today!

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