2008   REGISTRATION         NUMBER_________

DIVISION:   LATE MODEL STOCK CAR  $100.00

                       SUPER TRUCK                             75.00

                       LIMITED LATE MODEL            50.00

                       MINI                                                35.00

                       STREET                                          35.00

MAKE OF CAR/TRUCK________________________________

DRIVERS NAME________________________AGE____

ADDRESS______________________________________

CITY_____________________STATE_____ZIP______

PHONE #__________________WORK____________________

SS#_____________________________________

CAR OWNER_________________________________

ADDRESS____________________________________

CITY_____________________STATE____ZIP_____

PHONE

#_________________WORK_____________________

SS# OR FED. ID #_____________________________

CHECK TO BE MADE TO--- DRIVER OR- OWNER

(CIRCLE ONE PLEASE)  NUMBERS NOT APPROVED UNTIL ACCEPTED BY TRACK

APPLICATANTS SIGNATURE________________________

ACCEPTED BY TRACK______________________________

DATE_____________________