|
MARYSVILLE RACEWAY PARK
2008 REGISTRATION FORM
|
| |
DIVISION |
MEMBER
TYPE |
FEE |
CAR
NUMBER |
|
|
360 SPRINTS |
OWNER/DRIVER |
$70.00 |
CAR # |
|
|
WINGLESS SPRINTS |
OWNER/DRIVER |
$70.00 |
CAR # |
|
|
STREET STOCKS |
OWNER/DRIVER |
$70.00 |
CAR # |
|
|
MINI STOCKS |
OWNER/DRIVER |
$70.00 |
CAR # |
|
|
DRIVER ONLY*-List
Division |
|
$50.00 |
CAR # |
|
|
PITMAN ONLY-List
Division |
|
$50.00 |
CAR # |
|
| *If
you are both the owner and driver of the car, the membership cost
is $70.00 |
| Individual
Owner is $70.00. Individual driver is $50.00 |
|
|
MEMBER INFORMATION |
| Name: |
| Address: |
| City: |
| Phone:
( ) |
|
|
OWNER INFORMATION
(checks paid to car owner) |
| OWNER's
NAME: |
| Address: |
| City: |
| Phone:
( ) |
| Social
Security #: |
| Please
list one name only. Checks issued only with tax id # or social
security number\ |
|
|
INSURANCE BENEFICIARY
INFORMATION FOR DRIVER ONLY |
| Name: |
| Address: |
| City: |
| Relationship:
|
| Social
Security #: |
|
|
RESERVED PIT SPACES
$175.00 EACH/FIRST COME-FIRST SERVED BASIS |
| Number
of spaces: |
|
|
|
|
Make
checks payable to: |
Marysville
Raceway Park
P. O. Box 6209
Marysville, CA 95901
Phone #(530)743-1327 |
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