2011 ICEBREAKER 200 PRE-ENTRY FORM

Use this form if you want to pre-enter a single enduro race. The cost is $50. This will guarantee you a number and starting position for all the race. Entry fees are not refundable or transferrable, numbers may not be resold. The entry fee is for the car and does not include a pit pass. After you fill out this form and hit the "CLICK TO ENTER" button you will be directed to the PayPal payment page. The PayPal account is joemadore@hotmail.com, if you have any questions call 405-990-3990.

PRE-ENTRY FORM ICEBREAKER 200 ENDURO

Driver Name
Nickname
Address
City, State ZIP
Best Phone Contact #
E-mail
Car Year, Make & Mod
Sponsors, Passengers (info. for announcer)
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