EXCITING DIRT TRACK ACTION / FAMILY ENTERTAINMENT
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Car #____________
Class_____________
Driver's Info:
Please Fill out this Information
Name:__________________________________________________
Address:_________________________________________________
City:__________________________
State:______ Zip:_______
Phone #:__________________________
Social Security #:__________________________
Car Owner Information:
Please fill this out if different than above - If you are using a FEIN # Print it exactly how the business name is registered. Please make sure you you print the name exactly how it is on your SS card. Remember this is the person we will write all the checks to and who will receive the 1099.
Name:__________________________________________________
Address:_________________________________________________
City:__________________________
State:______ Zip:_______
Phone #:_______________________
Social Security #:_______________________
Registration Fees:
Modified: $50.00
Limited Late Model: $50.00
B Mod: $40.00
Hobby Stock: $30.00
4-Cylinder & Pure Stock: $20.00
Any Registration Paid After the Practice on April 10, 2010 is $10.00 more.
Please Mail Registrations to: Freeport Raceway Park 1910 S Walnut Freeport IL 61032
1910 S Walnut Rd
Freeport IL 61032
815-233-0390