form

CAR INFORMATION

Class (circle one): Hobby Stock Street Stock Late Model Modified

Car Number Make of Car Year

Color Fire Extinguisher Yes or No

Late Model weight exeception: No Yes If yes, indicate weight

Driver's information

Drivers Name Birthday

Address City, State, Zip Code

Home Phone Work Phone

Pit Crew Members:

Owners Information

Owners Name:

Address: Cirt, State, Zip Code

CHECK INFORMATION

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