2017 RoboPong 200 Presented by Bridgestone Entry Form - October 20-22, 2017
Team Information
Team Name Team Manager (person to contact for questions) Drivers Name (maximum 4 drivers) Co Driver's Name Co Driver's Name Co Driver's Name Chassis Brand Engine Type Address City State / Zip / Daytime Phone of Team Manager E-mail of Team Manager (We are having trouble with Yahoo accounts bouncing back, please leave the ".com" off your email if you are having trouble with your entry bouncing back) Transponder # (if you own one) Credit Card Number (VISA, MC, DISCOVER) NO AMEX! Expiration Number CCV Three Digit Security Code on Back of Card (VISA, MASTERCARD or DISCOVER) VERY IMPORTANT! All numbers must be 1 or 2 or 3 digits - No letters allowed! Please give your desired kart number - 1st choice - 2nd choice
Event Information (check all applicable boxes)
Race Date October 20-22 (Friday-Sunday) Class Entry (check box) (DOES NOT INCLUDE PIT PASS!) $696.97 TaG Entry Includes 1 set of YLC tires (includes sales tax) Transponder Rental ($10.70 per team) Please make selection No Transponder Needed 1 Transponder Rental - $16.05 Two Day Pitpass Driver and/or Crew You can also wait to buy your pit passes at NCMP Please make selection None, Will Purchase at NCMP 1 additional pass - $18 2 additional passes - $36 3 additional passes - $54 4 additional passes - $72
$696.97 TaG Entry Includes 1 set of YLC tires (includes sales tax)
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