1st Annual "The Classic" October 1, 2, 3, 2009 Rain Date: Oct. 4
$20,000to win ! K-C Raceway
OFFICIAL Dirt Track World Cup Late Model Classic Entry Form
ENTRY INFORMATION
OFFICIAL ENTRY FORM - 1st annual Dirt Track World Cup Late Model Classic
Please print ALL requested information AND include ENTRY FEE - failure to do so, will result in return of entry
MAIL TO: Schrader's K-C Raceway Entry: Modifieds $30 per car
P.O. Box 239 $75 per Late Model car if pre-entered by Sept. 25 date on envelope
Beaver, Ohio 45613 $100 per Late Model at pit gate Oct 2
schrader_jeff@yahoo.com
PLEASE INCLUDE CURRENT PHOTO OF CAR FOR INCLUSION IN NEWS PROGRAM
DRIVER:__________________________ AGE:____ CAR #:_________
Chassis ____________________ Engine Builder_________________
Yrs. Experience as a Driver_______________ Married/Single_____________
Occupation: ___________________________________________________
ADDRESS:__________________________ PHONE:__________________________
CITY:_________ STATE: __________________ZIP:________ E-MAIL:__________________
CAR OWNER: ___________________________COLORS:___________________________
ADDRESS:____________________________________ PHONE:___________________________
CITY:_____________________ STATE: __________________ZIP:________ E-MAIL:__________________
SPONSOR(S):_______________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
NAME & TAX INFORMATION OF 1099 RECIPIENT
NAME:____________________________________ SS#__________________ or FED
ID:____________________________________
ADDRESS:____________________________________ PHONE:__________________
CITY:____________________STATE:_______________ZIP:________ E-MAIL:__________________