MHM Custom Video Shoot

MHM Custom Video Shoot

Capturing Your Race Day Memories
Event Name: Mark Hagopian Memorial Race

Event Dates: September 23 & 24, 2022
Event Address: Keller Auto Raceway Plaza Park , Visalia, CA
Please fill the form below to register for a custom video shoot. If you have any problems with this form please email jennifer@richmediasocial.com or call 559-917-9300.
Driver Information
Driver's Name *

First Name Last Name
Parent's Name if Driver is a Minor

First Name Last Name
Best Contact Number *

Area Code Phone Number
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Car Details
Make
Model
License Plate Number *
Registration Payment

Race Day Video Shoot *

Video Shoot $ 599.00

100% refundable if canceled 48 hours prior to race day. Please email jennifer@richmediasocial.com for refunds.

Total $ 0.00

Credit Card

Apple Pay

Google Pay

Cash App Pay

Release & Agreement

Please read the terms & conditions before providing signature.
Driver's Signature or Parent/Legal Guardian of Minor Signature

Clear
Date Signed

Month Day Year
Date
Should be Empty:

Driver Information