Red Willow County Fairgrounds Track promoter: Jerry Bantam
West 5th and Q Streets Telephone: (785) 877-5353
McCook, Nebraska 69001 Email: frakrstr@ruraltel.net
2011 DRIVER REGISTRATION FORM
Driver's Name___________________________________________________________
Mailing address__________________________________________________________
City, State, Zip___________________________________________________________
Telephone Number______________________email:_____________________________
Owner's
Name________________________________Address_____________________
City, State, Zip__________________________________________________
Phone Number_________________ Social Security #_____________________required for 1099
WINNING CHECKS TO BE MADE PAYABLE TO:____OWNER____DRIVER
REGISTRATION FORM MUST BE FILLED OUT COMPLETELY OR NO PAY
REGISTRATION FEE Before April 1 After April 1
CLASS: _____IMCA MODIFIED $45.00 $60.00
_____IMCA STOCK CAR $45.00 $60.00
_____IMCA HOBBY STOCK $45.00 $60.00
_____305 SPRINT $45.00 $60.00
_____SPORT MOD $45.00 $60.00
PAYMENT CHECK # ____________________ CASH________________
Checks Payable to: Racing, 201 W Taft St, Norton 67654 (785) 877-5353
REGISTRATION IS FOR DRIVER NOT CAR. DRIVER MUST BE REGISTERED FOR EACH CLASS THEY RUN.
Reserved Parking available: $50 Yes____ No____ (Car number must be placed on Fence)
Requested
Car Number: