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254-628-2888 www.texasthunder.com
TEXAS THUNDER SPEEDWAY
DEMO DERBY REGISTRATION FORM 208 RED OAK DRIVE, HARKER HEIGHTS, TX 76548
DEMO DERBY DATE (circle one): April 19 or July 19
DATE:__________________ CAR #_________________ CLASS: DEMO DERBY DRIVER'S NAME: ______________________________________ SSN: ______________________ ADDRESS:_____________________________________________ PHONE #:__________________ CITY:__________________________________ STATE:___________ ZIP:__________________ EMAIL ADDRESS: _____________________________________ CAR OWNER'S NAME (if different from driver):____________________________________________ CAR OWNER'S ADDRESS: __________________________________________________________ SPONSOR'S PRIMARY SPONSOR: _________________________________ CITY:_______________________ SPONSOR: ___________________________________________ CITY:_______________________ SPONSOR: ___________________________________________ CITY:_______________________ SPONSOR: ___________________________________________ CITY:_______________________ SPONSOR: ___________________________________________ CITY:_______________________ SPONSOR: ___________________________________________ CITY:_______________________ |
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I agree to abide by all Texas Thunder Speedway Rules and Regulations. I hereby give Texas Thunder Speedway the right to use pictures of my car or myself for promotional purposes.
Driver's Signature: |
THE FOLLOWING INFORMATION IS NEEDED FOR IRS REPORTING
NAME: __________________________________________ SSN: ___________________________ ADDRESS:_________________________________________________________________________ |
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CAR #____________________ SPONSOR CARD - Y or N REGISTRATION FEE: Pre-Entry $30 Late Entry $40 REGISTRATION PAID:__________ DATE PD: ____________ INITIALS:____________ |