Plymouth Speedway

11631 W. 12TH RD. / Plymouth, IN. 46563 / (574) 936-0900

2008 DRIVERS REGISTRATION FORM

LATE MODEL / SPORTSMAN / MINI-STOCK / THUNDER CAR / FWD 4 CYLINDER   

CLASS (CIRCLE ONE): LM  SP  MS  TC  FWD    CAR # ____________

 

Driver’s Name: ________________________________________________________________________

 

Street Address: ________________________________________________________________________

 

City: ____________________________ State: ___________________ Zip Code: __________________

 

E-Mail Address: _______________________________________________________________________

 

Home Phone: (_______) ______________________ Work Phone: (________) ____________________

 

Are you at least 16 years old? Yes or No 2008 ROY Candidate? Yes or No

 

SOCIAL SECURITY OR TAX I.D. NUMBER OF PERSON OR ENTITY TO RECEIVE 1099 INFORMATION

 

Name or Entity: _______________________________________________________________________

 

Address: _____________________________________________________________________________

 

City: ______________________________ State: __________________ Zip Code: _________________

 

Phone: (________) __________________ SSN or Tax I.D. No.: _________________________________

 

Signature: ____________________________________________ (Title if Corp) ___________________

DRIVER / CAR INFORMATION

 

Vehicle Make: ________________ Yr.: _________ Model: __________________ Color: ______________

 

Sponsors: _____________________________________________________________________________

 

Years Racing: ________________ Championships: ____________________________________________

OPTIONAL INFORMATION

 

Occupation: ___________________________________________________________________________

 

Hobbies: ______________________________________________________________________________

 

Married: Yes or No Spouse’s Name: __________________________________________

DISCLAIMER: I understand that my signature here along with the proper registration fee makes me a member of the Plymouth

Speedway. I agree to abide by the racing rule book of Plymouth Speedway and it’s 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.

 

SIGNATURE: _________________________________________________ DATE: _________________

 

NOTE: ANY PAYOFF NOT PICKED UP ON RACE NIGHT  CAN BE PICKED UP AT THE NEXT RACE!