MARYSVILLE RACEWAY PARK
TAXI CAB OPEN
LIMITED LATE MODELS & STREET STOCKS
Saturday, March 19, 2011

(one form per registration)

DRIVER INFORMATION

Name: ___________________________________________________________________________________

Address:_________________________________________________________________________________

City:______________________________________________ State: ____________Zip:_________________

Phone # (_______) _______________-_______________________________

OWNER INFORMATION

Checks paid to car owner

Car Owners Name: ________________________________________________________________________

one name only

Address: _________________________________________________________________________________

City: _____________________________________________State: ____________Zip: __________________

Phone # (_______) ______________-_______________________________

Social Security #: _________________-_________-___________________

checks issued only with social security number

CAR DIVISION ______________________________________CAR #_______________

MAKE CHECKS PAYABLE TO:
Marysville Raceway Park
P. O. Box 6209
Marysville, CA 95901

BEFORE March 6, 2011 ENTRY FEE/PIT PASS $100.00

AFTER March 6, 2011 ENTRY FEE/PIT PASS $130.00

Pit Passes $40.00

Fees will be returned in event of a rain-out prior to event

CONTACT INFO: marysvilleracewaypark@hotmail.com

Phone (530) 743-1327