105 Speedway
P.O. Box 1284
New Caney TX 77357
CAR AND DRIVER REGISTRATION
Registration Fee:
$25.00 (For office use only: Date Paid:
Initials:
)
Drivers must be at least sixteen (16) years of age to
compete. Please complete this form entirely
by giving required
information in the blanks provided.
No numbers will be reserved until the registration fee is received.
PLEASE PRINT LEGIBLY.
CLASS:
CAR NUMBER:
JACKET
SIZE :
DRIVER
INFORMATION:
NAME:
ADDRESS:
CITY: STATE ZIP
PHONE:
CELL:
DATE OF BIRTH: SS#:
CAR OWNER (if other than driver)
NAME
SS#/EIN:
ADDRESS:
CITY: STATE: ZIP:
PHONE: CELL: EMAIL:
Return this registration form with payment to the address
above or to the Pit Office at the Track on race day.
Car numbers are not reserved until payment is received.
NOTE for Minors: The
Minor’s Release must be completely filled out before a minor is allowed in the
Pits.
This is an insurance
requirement.
I certify that the information given above is true and I
have, or will have, familiarized myself with all 105 Speedway rules and
regulations,
including car specifications and safety rules, and I specifically
agree to abide by all the rules of 105 Speedway.