We must have a
complete mailing address and Social Security Number of the person to
whom the checks will be made out to for our tax records, 1099 forms,
and any unclaimed checks.
Name:
Social Security Number
Address
City, State, Zip Code
REGISTRATION FEE $40
Please return this form and fees ASAP to: Boone County Raceway, Inc
%
Dennis Krohn
2559 Fairgrounds Rd
Albion, NE 68620