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MARYSVILLE
RACEWAY PARK (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 numberCAR DIVISION ______________________________________CAR #_______________ MAKE CHECKS PAYABLE TO: 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 |