20TH ANNUAL FLATLANDER FALL CLASSIC
SEPTEMBER 25 - 26, 2009
{RAIN OUT DATE – SEPTEMBER 27, 2009 @ 12:00 P.M.}
PRE REGISTRATION FORM
PLEASE CIRCLE OR HIGHLIGHT CLASS OF CAR
MODIFIED PRE-REGISTRATION $100 @ GATE $150
STOCK PRE-REGISTRATION $90 @ GATE $120
HOBBY STOCK PRE-REGISTRATION $75 @ GATE $105
ECONO PRE-REGISTRATION $60 @ GATE $90
SPORT MOD PRE-REGISTRATION $50 @ GATE $80
THIS DOES NOT INCLUDE DRIVER’S PIT PASS
IF YOU PRE-REGISTER AND CAN NOT MAKE THE RACE, YOUR REGISTRATION
FEE WILL BE RETURNED AND A HANDLING CHARGE OF $10.00 WILL BE KEPT FOR HANDLING PURPOSES
ALL PRE-REGISTRATION FORMS MUST
BE POST MARKED BY SEPTEMBER 12, 2009
MAIL CHECKS AND REGISTRATION FORM TO:
SHERMAN COUNTY SPEEDWAY
PO BOX 461
GOODLAND, KS 67735
{www.freewebs.com/shermancountyspeedway} email: scscra@yahoo.com
{Print or Type-please make legible}
DRIVER’S NAME: ______________________________________ IMCA D.L: ___________
ADDRESS: ___________________________________________________________________
CITY: ________________________ ST: _______ ZIP: __________
PHONE #: _______________________________________________
CAR # {1st Choice} __________ {w/ Letter} __________ {2nd Choice} __________
SOCIAL SECURITY #: ____________ - ________ - __________
______ I GIVE PERMISSION FOR MY NAME TO BE USED IN PROMOTIONS!
SIGNATURE: __________________________________________
Fill out below if PAYEE is different then driver
Name: ____________________________ SSN: _______________
Address: _______________________ City: ________________ St: _______ Zip: ________
