SUNSET SPEEDWAY DRIVER REGISTRATION

DATE_____________________________________

( ) LL MODEL $120.00 ( ) THUNDER $105.00

( ) MINI OUTLAWS $53.50 ( ) Mini Stocks $53.50

( ) PAD FEES ALL MEMBERS $105.00

 1^st choice of number__________ 2^nd choice of number______________

(note no X or three digit numbers)

Car Make_____________Model________________Year___________

Name Print_______________________________________________

Address in Full____________________________________________

                         ____________________________________________

Home Phone____________________Cell_________________________

e-mail_____________________________________________________

Do you qualify as a rookie for your division?________________________

Names of Pit Crew 1__________________________________________

2__________________________________________

3__________________________________________

4__________________________________________

Name of Sponsors ______________________________________________

____________________________________________________________

____________________________________________________________

Registration Paid ( )cash ( ) Check ( ) Pad Fees Paid ( ) cash ( ) check ( )

Registered Amount Paid $_________________Pad Amount Paid_______________

Received by_______________Date____________Approved Number___________