Event Registration Event (Select either or both events)(Required) Qualifying Weekend Race Weekend This field is hidden when viewing the formCompany(Required)Select CompanyBitNileEarnityTurnOnGreenAlzamendName (as it appears on government-issued ID)(Required) First Last Name for BadgeCompany(Required)Email Address(Required) Mobile Phone Number(Required)Date of Birth(Required) MM slash DD slash YYYY Shirt Size(Required)Select SizeSMLXL2XL3XLHotel Room Preference(Required)Select Room TypeI do not require lodgingKing RoomDouble RoomAccompanying Minors(Prior Approval Required)First & Last Name Name (as it appears on government-issued ID)Date of Birth Add RemoveQualifying Weekend Arrival Date(Required)Select DateThursday 5/19Friday 5/20Saturday 5/21Sunday 5/22Qualifying Weekend Departure Date(Required)Select DateFriday 5/20Saturday 5/21Sunday 5/22Monday 5/23Race Weekend Arrival Date(Required)Select DateThursday 5/26Friday 5/27Saturday 5/28Sunday 5/29Race Weekend Departure Date(Required)Select DateFriday 5/27Saturday 5/28Sunday 5/29Monday 5/30Tuesday 5/31Will you require ground transportation (Airport to Hotel)?(Required)Select Yes or NoYesNoFlight Arrival Information (Please provide at least 14 days prior to event)Arrival DateAirlineFlight Number Add RemoveFlight Departure Information (Please provide at least 14 days prior to event)Departure DateAirlineFlight Number Add RemoveAny special dietary restrictions?Any special needs or health concerns that we should be made aware of to make the most out of this experience (mobility, hearing, vision, etc.)?Please select which events you plan to attend - Qualifying WeekendFriday 20th - Fast Friday Track Activity Dinner Saturday 21st - Armed Forces Qualifying Day Track Activity Dinner Sunday 22nd - Armed Forces Qualifying and Pole Day Track Activity Dinner Please select which events you plan to attend - Race WeekendFriday 27th Track Activity - Practice, Pit Stop Competition Carb Day Concert BitNile “Legends of Indy” Party @ Ed Carpenter Racing Saturday 28st Public Drivers Meeting and Garage Tour Todd Ault 500 - Go Karting Challenge (Spectator) Todd Ault 500 - Go Karting Challenge (Participant) Dirks Bentley Concert Sunday - 106th Running of the Indianapolis 500 Mile Race Race Snake Pit (Electronic music concert with Martin Garrix, Galantis, Steve Aoki and deadmau5. All attendees must be over 18 years of age and will not participate in pre-race BitNile hospitality, pit tour, etc.) Post Race Casual Dinner Monday 30th BitNile Holdings Board Meeting Indy 500 Celebration (in the event of a victory) PhoneThis field is for validation purposes and should be left unchanged. Δ
