DRIVER/OWNER INFORMATION

 

 

MUST BE COMPLETED AND TURNED IN TO RECEIVE PAY-OUTS!

 

BACKGROUND

 

Driver_________________________________  Division______________________________  Car #______   Age _________  

 

Street_________________________________________________________________________________________________

 

City                                                                                                                            State        Zip Code                       ___

 

Phone home_____________________ cell/work/shop______________________ e-mail address________________________

 

Occupation_________________________________________Employer____________________________________________

 

Spouse_________________________________________Children_______________________________________________

 

RACE TEAM

 

Name_________________________________________________________________________________________________

 

Car Year_________________________Make________________________________Model_____________________________

 

Engine______________________________________________Builder_____________________________________________

 

Chassis______________________________________________ Built by____________________________________________

 

Colors_______________________________________________ Wins on car_________________________________________

 

Crew Chief___________________________________________ Chief Mechanic______________________________________

 

Crew members___________________________________________________________________________________________

 

Car owner_______________________________________________________________________________________________

 

RACING EXPERIENCE

 

Years__________ Racing Since_________Championships_______________________________________________________

 

Career wins/highlights (by division, track, and years)___________________________________________________________

 

______________________________________________________________________________________________________

 

What is your hometown newspaper?_________________________________________________________________________

 

How did you get started racing?____________________________________________________________________________

 

Relatives in racing_______________________________________________________________________________________

 

SPONSORS

 

_______________________________________________________________________________________________________

 

_______________________________________________________________________________________________________

 

PERSON REPORTING INCOME FROM RACING ACTIVITIES MUST PROVIDE THE FOLLOWING INFORMATION:

 

Name______________________________________________________________ Phone_____________________________

 

Address______________________________________________________________________________________________

 

City________________________________________________ State_______________________   Zip____________________

 

 

Social Security or tax ID number_________________________________________________________________________

 

I consent to the use of the information provided and photos taken for general racing publicity.

 

 

Signature_________________________________________________________________________Date__________________