Rescheduled Myrtle Beach 400
March 22, 2013 Entry Blank
(For Drivers that did NOT enter in the original November 18, 2012 event)
ENTRY FEES:
NASCAR LATE MODELS $150.00
SELLM LIMITEDS $125.00
*Driver Name_______________________________
NASCAR License#_______________Phone#_______________
Address________________________________City______________Zip_______
Social Security#________________________E-mail_______________________
Car Number___________Make/Model__________________________________
*For 1099 purposes, if payoff is to be made to someone other than the above driver. Please indicate by filling in the requested information below…
Name_______________________________
Address_______________________________City______________Zip________
SS#/Federal ID______________Phone#________
*All Drivers entered in the “Myrtle Beach 400 events” events are required to have a valid NASCAR license. Temporary licenses are available at the track. This is a NASCAR sanctioned event.
