Pre-Race Entry Fee - $25 (No Refunds)

Deadline – September 17, 2010

Race Day Entry Fee - $40

(Early entries will be placed in the starting line-up by date received!)

Mail Registration Form and Fees to: Solomon Valley Raceway

                                                            PO Box 34

                                                            Beloit  KS  67420

CAR & DRIVER REGISTRATION FORM

PLEASE PRINT CLEARLY

DRIVER NAME______________________________________________________

ADDRESS___________________________________________________________

CITY___________________________________ STATE_____ ZIP CODE_________

HOME PHONE (_____)_______________ CELL PHONE (_____)________________

In case of emergency, please provide contact name and phone number:

________________________________________PHONE#____________________

EMAIL:_____________________________________________________________

CAR NUMBER: CHOICE #1: ________ CHOICE #2: ________CHOICE #3:________

SCOREKEEPER NAME:_________________________________________________

You are agreeing that you and your crew will abide by, and will follow the rules and instructions from Solomon Valley Raceway, their staff and officials during this event.  Solomon Valley Raceway officials will enforce the rules of this event to the best of their ability.  You, the driver, are responsible for all taxes, fees and assignments and are solely responsible for reporting any winnings.  You are agreeing not to hold Solomon Valley Raceway responsible for any accidents or damage during this event.

Driver/Owner Signature _____________________________________ Date________________

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For Official Use: Car Number Assigned __________ Entry Fee Paid $_________Date_________