2012 RACE WEEK

February 3-11, 2012

LOCAL CAR REQUEST FORM

NAME:                                                                                                                      

 ADDRESS:                                                                                                              

 PHONE:                                                                                                                   

 EMAIL:                                                                                                                      

 CAR #:                                                                                                                      

CAR DIMENSIONS:                    WIDTH                                                FEET

                                                      LENGTH                                           FEET

NAME OF TRACK WHERE YOU RACE:                                                                                                                          

Please make sure that all of the requested information is completed.

 Please submit your information by Monday, January 23, 2012 to:

Chambersburg Mall

Attn: Dore Diehl

864 Chambersburg Mall

Chambersburg, PA 17202

 or deliver to the Mall Management Office.