Maxxis Shootout Series 2015
Driver's Name
*
First Name
Last Name
Age
*
Birth Date
*
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Day
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Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Number
*
-
Area Code
Phone Number
Home Number
-
Area Code
Phone Number
E-mail
*
Emergency Contact Information
Contact Name
*
First Name
Last Name
Relation
Will this person be at CMP on Race Day?
Yes
No
Phone Number
*
-
Area Code
Phone Number
Alternate Phone Number
*
-
Area Code
Phone Number
Allergies or Medical Conditions
*
Race Information
Choose Race Date
*
May 30, 2015
July 25, 2015
September 26, 2015
November 21, 2015
Racing Class
*
Tag Cadet
Junior Tag
Senior Tag
Senior B&S LO206
Junior LO206
LO206 Cadet*
(*Minimum Participation Required.)
Entry Fees
Choose Race Class
*
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( X )
Mini, Micro, & Cadet LO206
$
75.00
All Other Classes
$
75.00
Non-Participants & Spectators
$
10.00
Quantity
1
2
3
4
5
6
7
8
9
10
Transponder
$
15.00
Total
$
0.00
Transponder #
Kart #
Submit
Should be Empty: