Personal Information

Driver's Name
Address
City
State / Zip	/
Phone
E-mail
Transponder #
Credit Card Number (Visa, MC, Discover) No AmEx
Expiration Number
CCV Three Digit Security Code on Back of Card
Please give your desired kart number	- 1st choice - 2nd choice

Event Information (check all applicable boxes) - Entry is FREE this year!

Senior Class Entry (check box & select class)
$0.00 Select TaG HeavyYamaha Senior CanClone Senior
JUNIOR Class Entry (check box & select class)
$0.00  Select SSX Junior Can (12-15 yrs) Yamaha Junior Sportsman
KID KART Class Entry (check box & select class)
$0.00  Select Kid Kart
RENTAL Transponder - 1 Per Driver (check box & select)
$10.70  Select None Needed Rental Transponder - YES
Pit Passes DRIVER and Crew Members Must Have Pit Pass You can also purchase pitpasses at the track	Please make selection No Additional Passes Needed 1 pass - $10 2 passes - $20 3 passes - $30 4 passes - $40