Wild West Speedway MSWC entry form

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Clinton Speedway

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MSWC PRE-ENTRY FORM
MICRO SPRINT WORLD CHAMPIONSHIP PRE-ENTRY
Race Date: October 21-24, 2010
Pre-entry opens: July 30, 2010 @8:00am
All fields in this form must be completed. You will then be directed to the PayPal page to complete your pre-entry payment. Entry fee is $200 and includes the drivers pit pass for race days (not the Thursday practice).

Driver Name*

First

Last

Driver Home Town*

Driver Age*

Car Number*

No duplicate numbers. If you request a number that
has already been taken we will contact you.

CAR OWNER INFORMATION

Car owner can be same as driver. Owner may be a company or individual. Prize money will be paid to owner and reported to owner SSN or FEIN.

Owner Name*

First

Last

Address*

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

SSN or FEIN (no dashes)*

Best Contact Phone #*

###

####

Second Contact Phone #

###

####

Email*

CAR INFORMATION

Car information for Program, Press Releases and Announcer. There is also a place to upload a picture for the website and the souvenir program.

Chassis*

Engine & Builder*

Sponsors

Upload a Picture of Car / Driver

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