Midwest Indoor Championship Sign Up – Pay Online Complete the form below if you wish to sign Up for the MIC and pay the entry fee online. Please one form per racer, Thank You MIC Sign Up - Pay Online "*" indicates required fields Name* First Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*1st Class*Select ClassTouring Car 25.5Touring Car 21.5Modified Touring CarStock GTP 17.5Super Stock GTP 13.5Modified GTPGT12 (SJT Rubber Tire)World GT-R 17.5USVTAUSGT 21.5Formula One 25.51st Transponder #*Register 2nd Class?* No Yes 2nd Class*Select ClassTouring Car 25.5Touring Car 21.5Modified Touring CarStock GTP 17.5Super Stock GTP 13.5Modified GTPGT12 (SJT Rubber Tire)World GT-R 17.5USVTAUSGT 21.5Formula One 25.52nd Transponder #*Register 3rd Class?* No Yes 3rd Class*Select ClassTouring Car 25.5Touring Car 21.5Modified Touring CarStock GTP 17.5Super Stock GTP 13.5Modified GTPGT12 (SJT Rubber Tire)World GT-R 17.5USVTAUSGT 21.5Formula One 25.53rd Transponder #*Register 4th Class?* No Yes 4th Class*Select ClassTouring Car 25.5Touring Car 21.5Modified Touring CarStock GTP 17.5Super Stock GTP 13.5Modified GTPGT12 (SJT Rubber Tire)World GT-R 17.5USVTAUSGT 21.5Formula One 25.54th Transponder #*Price: 1 Class Price: Price: 2 Classes Price: Price: 3 Classes Price: Price: 4 Classes Price: Total Can we email you in the future?* Yes No Payment Method*PayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name FacebookThis field is for validation purposes and should be left unchanged. Δ
