"Boone County Raceway"       
                       2012 REGISTRATION FORM                        
   (Please fill out legibly and completely)
CAR INFORMATION
        Class (circle one):    IMCA  Hobby Stock             Street Stock            Late Model        
IMCA Modified       IMCA  Sport mod   IMCA Sport Compact

       Car Number                                      Make of Car                                         Year

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Color                                                            Fire Extinguisher         Yes or No
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Late Model weight exeception:    No   Yes                 If yes, indicate weight
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Driver's information
Drivers Name                                                                                             Birthday
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Address                                                         City, State, Zip Code
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Home Phone                                                                        Work Phone
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Pit Crew Members:
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Owners Information
Owners Name:

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Address:                                                                   City, State, Zip Code
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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
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Address                                                                    City, State, Zip Code
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REGISTRATION FEE $40

Please return this form and fees ASAP to:
 
    Boone County Raceway,
 % Dennis Krohn
    2559 Fairgrounds Rd, Albion, NE 68620