Entry Form
Circle class entering: MODIFIED MINI CAR STOCK
MINI CAR
STOCK TRUCK
MINI VAN WIRE TRUCK
Indicate Race Location & Date: ________________________________________________
Driver's Name: ______________________________________ Date of Birth: ___________________
Driver's License Number: _______________________________________________
Social Security Number: ________________________________________________
Address: ____________________________________________________________________
City: _____________________ State: ______ Zip: _______________
Home Phone: _____________________ Work/Cell Phone: ______________________
Number Requested: _______ Year/Make/Model: _____________________________________
Color of Car: ________________
I have received a copy of all rules and
regulations and agree to abide by all said rules as stated. I further grant
Ramer Race Promotions permission to use
my name and likeness as captured on
photo or videotape in any advertising or promotional material they produce.
Signature of Driver: ___________________________________________________
Date: _______________ Amount Paid$: ______________________