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 NameLast Name
Parent's Name if Driver is a Minor

First NameLast Name
Best Contact Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / 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

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Cash App Pay

Release & Agreement

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

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Date Signed

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Date
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Driver Information