List your number choices, per kart. No Blank Spaces

Blank Spaces or Duplicate numbers will void entry!

1st

2nd

3rd

4th

Driver:

Address:

Phone:

E-mail:

City:

State/Prov:

Zip/Post. code:

Stk Med, 350#

Stk Hvy, 375#

Stk Spr Hvy, 400#, (200# driver)

Stk Lite, 325#

Choose all classes per kart:

Entry Form

Sr. Animal Champs, 410#

Jr 2, Aqua-290# Ages 7-12

Jr 3, Gold-320# Ages 12-15

Animl, 360#

Jr Sprt Champ, Aqua-315#  7-12

Jr Champ, Unres.-345#  11-15

Jr Anim Champ, Black-355#  11-15

Jr Animal, Gold-320# 12-15

Total:

Price each

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$75.00

$25.00

$35.00

$10.00

$20.00

Pit Pass, Driver and Adults

Pit Pass, non-drivers 10 & under

Reserved Parking, Front Row

Reserved Parking, Second Row

$55 Pre-Entry, before Oct. 5/ $75 after midnight

Fill out the form completely. It is not necessary for you to buy pit passes now, it just makes it easier for you to get that cost out of your way and put it on your credit card.

This form will be forwarded to my email address,

You will be emailed an invoice to the address above. Everything will then be taken care of on PayPal. After notification of payment I will register your number and assign your pit spot or spots.

All entries to be paid at track, cash only!