2014 REGISTRATION FORM
 
Car Number #: ________________
Class (circle one):
Modified Super Street Stock Pure Thunder Stock 600 Sprints
       
Driver’s Name: ___________________________________________________________________________________________________
Street Address: __________________________________________________________________________________________________
City: ____________________________________________________________ State: _______________________ Zip:______________
E-Mail Address: __________________________________________________________________________________________________
Phone: (_______) __________________________
Are you at least 18 years old? Yes No (Parental Release required)
 
INFORMATION FOR: SOCIAL SECURITY OR TAX I.D. NUMBER OF PERSON OR ENTITY TO RECEIVE 1099 (PAYOFF CHECKS MADE OUT TO)
 
Name or Entity:___________________________________________________________________________________________________

E-mail Address: ___________________________________________________________________________________________________

Phone: (_______) __________________________
SSN or Tax I.D. No.: _(W-9 Form Required)_______________________________________________________________________________
Signature: ___________________________________________________________________________________________
(Title if Corp)______________________________________________________________________________________________________
 
Disclaimer: I understand that my signature here makes me a member of Plymouth Speedway. I agree to abide by the racing rule book of Plymouth Speedway and its interpretation by officials. I hereby give my permission to use photographs of myself and/or race car as part of their racing publicity promotions. I agree not to hold Plymouth Speedway responsible for disqualification or damage to either car or driver and I agree that I consider the track is in safe racing condition when I take part in any racing activity.

*Note: Checks will be made payable to the person listed on your registration form as the recipient of the 1099.

 
Signature: __________________________________________________________ Date: _____________________________
 
 
2014 WEB and MEDIA FORM
 
Car Number # ________________
Class (circle one):
Modified Super Street Stock Pure Thunder Stock 600 Sprints
       
Driver’s Name: ___________________________________________________________________________________________________
Nickname: ___________________________________________________________
Number Of Years Racing: _________________ Championships: __________________________
Hometown: _____________________________________________________________________________________________________
Chassis Manufacturer: _______________________ Engine Builder:___________________________
 

Racing Accomplishments: (Tracks raced, races won, track records, Series raced in) ______________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

 

Sponsors: _______________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

 

 

Misc Info: _______________________________________________________________________________________________________

_______________________________________________________________________________________________________________

_______________________________________________________________________________________________________________

 
Email Address: ___________________________________________________________________________________________________

Website Address: _________________________________________________________________________________________________

 
Plymouth Speedway
Plymouth, Indiana
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All Rights Reserved