driver registration

2008 Driver Registration

Class:_____________ Car No._______________

Driver ___________________________________ Years Racing ______________

SSN:________ - _________ - ________________ Home Phone ( ) -

Address __________________________________ Cell Phone ( ) -

City _____________________ State ___________ Email __________________________

Zip ____________________ Birthdate________________________

Car Owner (If Different) __________________________Checks will be payable to Driver Only

SSN or Tax ID ______-______-____________ Home Phone ( ) -

Address _________________________________ Cell Phone ( ) -

City ____________________ State___________ Email __________________________

Zip __________________ T-Shirt Size _____________________

Jacket Size _____________________

Home Town News Paper ____________________________________________________

Please list any medical conditions or reactions that you have. This will assist use if you should need to be treated for an emergency.____________________________________________

________________________________________________________________________

Do you qualify as a ROOKIE at JMS for 2008 _____ Yes _____No

Car Type	LIC	FEE	Cash	Check#	Total	DATE RCVD
Late Model	$185	$35			$220
Modified	$90	$35			$125
Stock	$90	$35			$125
Hobby Stock	$90	$35			$125
Cruisers	$90	$35			$125
4 Cylinder	$90	$25			$115

2 Main Sponsors (1)___________________________(2)___________________________

Pit Crew _________________________________________________________________

PLEASE NOTE: A W-9 FORM MUST BE FILLED OUT OR NO CHECK WILL BE ISSUED.

(402) 773-5538 ext: 539

Race Day Track Phone

(402) 724-3100

Mail Completed form to:

JMS

Po Box 524

Sutton, Ne. 68979

(402) 773-5538 ext: 539

Race Day Track Phone

(402) 724-3100

jmsinfo@junctionmotorspeedway.com