California Healey Week 2023 On-Line Registration If you don't want to register online & pay via Paypal, click here to download a PDF to mail. Registration PDF Please do not use Auto fill on the form below! Please allow pop ups to get to the PayPal payment page! First Name (required) Last Name (required) Spouse / Guest First Name Spouse / Guest Last Name Additional Person First Name Additional Person Last Name Additional person First Name Additional Person Last Name Address (required) City (required) State / Province (required) Zip Code (required) Phone (required) Cell Phone Club Affiliation Country if not U.S.A. Your Contact Email (required) ___________________________________________________________________________________________________________________________________ Enter year of Car 1 Are you bringing a trailer?*-No or Yes--NoYes Enter the model of Car 1 from one of the areas below Original owner / family?NoYes *-select model 100 4 cylinder--BN1BN2100M - Lemans100S *-select model 100 6 cylinder--BN4BN6 *-select model 3000--BN7 2-seaterBT7 4-seaterTricarbBJ7BJ8 single lightBJ8 dual light *-select Bugeye model--AN5 *-select Sprite model--AN7AN8AN9AN10 *-select other Healey model--Jensen HealeyNash HealeyNasty Boy _________________________________________________________________________________________________________________________________ Enter year of Car 2 Are you bringing a trailer? *-No or Yes--NoYes Enter the model of Car 2 from one of the areas below Original owner / family?NoYes *-select model 100 4 cylinder--BN1BN2100M - Lemans100S *-select model 100 6 cylinder--BN4BN6 *-select model 3000--BN7 2-seaterBT7 4-seaterTricarbBJ7BJ8 single lightBJ8 dual light *-select Bugeye model--AN5 *-select Sprite model--AN7AN8AN9AN10 *-select other Healey model--Jensen HealeyNash HealeyNasty Boy ___________________________________________________________________________________________________________________________________ Pricing Registration for two including car --------- After May 18, 2023 ----------------------------(enter 1) @ $ 495 Reg. for 1 w/car or # of additional people ----------- After May 18, 2023 1 w/car or # of addnl people @ $270 Optional Registration Cut-off August 15 th Virginia City / V&T Railroad Tour ------------------------ @ $40 per person Sold out !! Put a note in the comment area to be put on a wait list Total: --------------------------------------------- USD Please complete the rest of the form below. When finished, make sure to check the little checkbox, click on the "Click to Register" button first, then click on the "PayPal" button separately. If you don't do both, we will not have all of your registration information. Other Events Funkana- Tell us how many people --------------------------- Ladies Tech Session ------------------------------------------------ Healey Tech Session ------------------------------------------------ Regalia ------------- If you want your Regalia at the event, you must order it at the web site link below before July 18 !! Regalia Web Site The following checkbox is required to register By checking this box, I/we release the Golden Gate Austin Healey Club, Austin Healey Club USA, and Austin Healey Club of America, its officers and members, and all other event sponsors and organizers from any and all liability for any loss, damage or other claim on account of injury to persons or property resulting from my/our participation in California Healey Week 2023, including travel to and from the event. I further attest that the registered car(s) is/are covered by suitable liability insurance. You will need to click the "Register" button first and then the "PayPal" button separately! You have to click on both!!!! Please allow pop ups to get to the PayPal payment page! Please look for registration completed or any error messages at the bottom of this form
