DRIVER REGISTRATION


DATE

NAME

ADDRESS , CITY ,STATE ZIP

PHONE(DAY) (NIGHT) SS# - -

Number of years racing and type of racing.



CLASS: Bomber Super Street Front Runners Sport Mod Other:

Type of Car: Year: Engine Size:

Car Number (1st choice) (2nd choice)


SPONSORS







INSURANCE
CC Speedway carries insurance for the race track, car owners, drivers, sponsors, spectators and
employees. Insurance is in effect only if the participant was signed in at the Pit Gate on the day
of the injury. Claims will be covered only to the limits of our coverage amounts. Any claim of injury
must be reported the day it happens or injury will not be covered by insurance policy.

The information filled out above is true and correct to the best of my knowledge. I have read the insurance statement above
and I understand and will abide by it.

The digital signature below is to be considered legal and binding.
SIGNED: DATE: