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NAME:_______________________________________________________
ADDRESS:___________________________________________________
CITY:________________________STATE:____________ZIP:__________
HOME PHONE_______________________
EMERGENCY PH NUMBER _______________________
PLATE /SLED #___________________
CLASS
| PRICE
|
|
| MAKE ---MODEL ------YR
| AMOUNT
| VINTAGE "A"
| 10.00 | |
| | | | VINTAGE "AA" | 10.00 | | | | | VINTAGE OPEN | 10.00 | | | | | STOCK APPEARING 500
| 10.00
|
|
|
|
| STOCK APPEARING 600
| 10.00
|
|
|
|
| STOCK APPEARING 700
| 10.00
|
|
|
|
| STOCK APPEARING 800
| 10.00
|
|
|
| | STOCK APPEARING 1000
| 10.00
|
|
|
|
| SUPER STOCK 500
| 15.00
|
|
|
|
| SUPER STOCK 600
| 15.00
|
|
|
|
| SUPER STOCK 700
| 15.00
|
|
|
|
| SUPER STOCK 800
| 15.00
|
|
|
|
| SUPER STOCK 1000
| 25.00
|
|
|
|
| HEAVY MOD 440
| 25.00
|
|
|
|
| HEAVY MOD 500
| 25.00
|
|
|
|
| HEAVY MOD 600
| 25.00
|
|
|
|
| HEAVY MOD 700
| 25.00
|
|
|
|
| HEAVY MOD 800
| 25.00
|
|
|
|
| HEAVY MOD 1000
| 25.00
|
|
|
|
| PRO STOCK 500
| 25.00
|
|
|
|
| PRO STOCK 600
| 25.00
|
|
|
|
| PROSTOCK 700
| 25.00
|
|
|
|
| PRO STOCK 800
| 25.00
|
|
|
|
| PRO STOCK 1000
| 25.00
|
|
|
|
| OPEN MOD 440
| 25.00
|
|
|
|
| OPEN MOD 500
| 25.00
|
|
|
|
| OPEN MOD 600
| 25.00
|
|
|
|
| OPEN MOD 700
| 25.00
|
|
|
|
| OPEN MOD 800
| 25.00
|
|
|
|
| TOP GAS 1000
| 25.00
|
|
|
|
| OUTLAW 1
| 25.00
|
|
|
|
| OUTLAW 2
| 25.00
|
|
|
|
| OUTLAW 3
| 25.00
|
|
|
|
| OUTLAW 4
| 25.00
|
|
|
|
| TRAIL STOCK 600 & Down
| 10.00
|
|
|
|
| TRAIL STOCK 601 to 800
| 10.00 | | | | | | TRAIL STOCK 801 to OPEN OPEN) | 10.00 | | | | |
HEAVY MOD STOCK 1 25.00
HEAVY MOD STOCK 2 25.00
FACTORY MOD 2 25.00
| SUB TOTAL |
$_________________________ |
| $7 PER CLASS INSURANCE |
$_________________________ |
| TOTAL |
$_________________________ |
AUTHORIZED SIGNATURE________________________________________
Pit passes will be given when the Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement is signed and MRRSIDR Membership is signed to complete registration.
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