DRIVER REGISTRATION
DATE___________________________
NAME_______________________________________
ADDRESS________________________________, CITY_______________________ ZIP__________
PHONE(DAY)_____________________(NIGHT)_______________________ SS#_____-____-______
Number of years racing and type of racing.________________________________________________
____________________________________________________________________________________
CLASS:___Bomber ___Super Street ___Texas Thunder ___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.
SIGNED:___________________________________________ DATE:__________________________