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MARYSVILLE RACEWAY PARK WINGLESS SPRINT NATIONALS
October 5 & 6, 2007
(one form per registration)
DRIVER INFORMATION
Name: ___________________________________________________________________________________
Address:_________________________________________________________________________________
City:______________________________________________ State: ____________Zip:_________________
Phone # (_______) _______________-_______________________________
OWNER INFORMATION
Checks paid to car owner
Car Owners Name: ________________________________________________________________________
one name only
CAR #____________________
Address: _________________________________________________________________________________
City: _____________________________________________State: ____________Zip: __________________
Phone # (_______) ______________-_______________________________
Social Security #: _________________-_________-___________________
checks issued only with social security number
MAKE CHECKS PAYABLE TO:
Marysville Raceway Park
P. O. Box 6209
Marysville, CA 95901
BEFORE Sept. 15, 2007 $100.00 (driver & car only)
AFTER Sept. 15, 2007 $150.00 (driver & car only)
Pit Passes $37.00
DRIVER ONLY - INSURANCE BENEFICIARY INFORMATION
Name: ____________________________________________________ Relationship: ___________________
Address: _________________________________________________________________________________
City: _________________________________________________ State: ___________Zip: ______________
Social Security #: _______________-____________-_____________________
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