ALLEGHENY MTN. RACEWAY
2008 CAR / DRIVER REGISTRATION
NICKNAME (IF APPLICABLE FOR ANNOUNCER)______________________________________________
ADDRESS___________________________________________________PHONE_____________________
CITY___________________________________________ STATE_______________ ZIP______________
OWNER'S NAME (if not driver) _____________________________________________________________
ADDRESS______________________________________________________________________________
CITY___________________________________________ STATE_______________ ZIP______________
PHONE NO.________________________________ E-MAIL ADDRESS:_____________________________
LOCAL NEWSPAPER/RADIO_______________________________________________________________
_______________________________________________________________________________________
CLASS OF CAR (PLEASE CHECK ONE)
( ) MINI STOCK ( ) 270cc MICRO SPRINT
( ) STREET STOCK ( ) SPORTSMAN MODIFIED
( ) PURE STOCK ( ) 4 CYL. CHARGER ( ) 600cc MICRO SPRINT
( ) E MOD ( ) LATE ( ) OTHER_____________________________________________
CAR NUMBER REQUESTED________________________________
IN THE CASE THE NUMBER YOU REQUESTED HAS ALREADY BEEN TAKEN, PLEASE LIST
YOUR NEXT CHOICES IN ORDER OF PREFERENCE: (NO 3 DIGIT NUMBERS PLEASE)
1.______________________ 2._____________________ 3._____________________
PRIMARY SPONSORS (PLEASE INCLUDE TOWN)_____________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
OTHER SPONSORS (PLEASE INCLUDE TOWN)_______________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
FAMILY INFORMATION
BIRTH DATE__________________ SPOUSE/SIGNIFICANT OTHER'S NAME________________________
CHILDRENS' NAME(S)____________________________________________________________________
IF YOU WISH TO BE PAID BY THE TRACK AND BE INCLUDED IN THE ANNUAL POINT FUND, YOU MUST
PROVIDE A SOCIAL SECURITY NUMBER. EARNINGS MAY BE REPORTED FOR TAX PURPOSES. IF THE
DRIVER IS NOT THE OWNER, PLEASE SPECIFY WHOSE SSN IS BEING PROVIDED. ALL EARNINGS
INCLUDING POINT FUND WILL BE PAID AND REPORTED TO THAT PERSON UNLESS THE TRACK IS
NOTIFIED OTHERWISE IN WRITING BY THE PERSON WHOSE SSN IS LISTED BELOW.
S.S. #________________________________________ OWNER ( ) DRIVER ( )
TRACK USE ONLY: DATE OF REGISTRATION_______________ AMOUNT PAID_________________ OFFICIALS INITIALS___________
