October 4th
Season Finale Registration (rescheduled from Sept. 13th)
PLEASE COMPLETE AND RETURN THIS FORM TO THE
SPEEDWAY OFFICE BY MONDAY SEPT. 29th
for preregistration fee
NO CHECKS WILL BE ISSUED UNTIL THIS FORM IS COMPLETED
AND RETURNED!
*CHECK ONE ____Late Model - $75 PRE-Registration ($100 at the gate)
____Street
Stock - $50 PRE-Registration ($75 at the gate)
Check Event Info on Website for Times
Please register early to help us operate an efficient event!
CAR #_______
PURSE CHECK PAYABLE TO:
NAME:_____________________________________________________________________________
MAILING
ADDRESS__________________________________________________________________
___________________________________________________________________________________
TELEPHONE # (DAY)__________________________
EVENINGS______________________________
SOCIAL SECURITY # OR TAX ID
#_________________________
(TAX # MUST BE REGISTERED TO NAME
ABOVE)
DRIVER
INFO:
OWNER INFO:
NAME__________________________________ NAME ____________________________________
ADDRESS_______________________________ ADDRESS_________________________________
________________________________________ _________________________________________
PHONE ( DAY
)___________________________ PHONE (
DAY )____________________________
PHONE ( EVE
)____________________________ PHONE (
EVE )____________________________
S.S.#____________________________________ S.S.#_____________________________________
DRIVERS
LIC.#____________________________ CAR INFO:
STATE_________
EXPIRATION_______________
MAKE___________________________________
BIRTH DATE_____/_____/_____
YEAR________ENGINE__________________
HOME NEWSPAPER________________________ ENGINE BUILDER_________________________
HOME RADIO
STATION_____________________ CHASSIS
BUILDER________________________
FAVORITE RACING
PAPER___________________
SPONSORS_______________________________
_________________________________________ ________________________________________
I UNDERSTAND THE RULES @ CPS AND AGREE
TO ABIDE BY ALL RULES AND DISCLAIMERS AS STATED. I ALSO AGREE TO ABIDE BY ALL
OFFICIALS' DECISIONS
CAR
OWNER_____________________________ WITNESS_________________________________
DRIVER__________________________________WITNESS_________________________________
DATE_____________.
MAIL TO:
CENTRAL PA SPEEDWAY
PO BOX 125
OSCEOLA MILLS, PA 16666