Abilene Speedway Registration Form

Please Print Legibly

Driver:

Social Security number: _______-_____-_______ Date of Birth: ______/______/______

Driver Name: _____________________________________________________________________

                                        First                                Middle                                   Last

Address: ______________________________City, State, Zip:__________________________

Home Phone: (______)__________________ Work Phone: (______)____________________

E-mail Address________________________________              

Owner: (If same as driver just mark "Same")

SSN/Fed ID: ________________________ Date of Birth: ________/_______/_______

Name /Company Name: ________________________________________________________

Address: ______________________________City, State, Zip:_____________________________

Home Phone: (______)                                     Work Phone: (______)                                              

Classification of Car: (circle one)

IMCA Modified       IMCA Stock Car       IMCA Hobby Stock      Limited Late Model             

              So. Ltd SportMods               Pure Stock           Jr. Mini Stock    

Car #:  1st Choice____________2nd Choice  _____________3rd Choice  _____________

Sponsors: Main Sponsor to be listed in program:____________________________________

Other sponsors: ______________________________________________________________

I will abide by the rules of Abilene Speedway as listed in the 2008 rulebook for this racing season.  I will not hold Abilene Speedway, its owners, or any officials responsible for any physical injury or damage to my vehicle(s).

I understand a breathalyzer test may be required at any time.  I understand refusal to take the test or failure of the breathalyzer test will result in disqualification with no pay or points.

Signed:_______________________________ Signed:_______________________________

(Participant)                                                          (Track owner)

Registration Fee $25.00