1200 Outlaws $ 60.00 High Plains Midget $ 60.00   1200 Outlaws/HPM $ 100.00  (revised 6/04/14)

Car #:  1st Choice___________ 2nd Choice  ____________ 3rd Choice__________

Driver: (Please Print Legibly)

Social Security number: _______-_____-_______ Date of Birth: ______/______/______

Driver Name: ________________________________________________________________

Address: _____________________________________City, State, Zip:__________________

Home #: (____)_________________________Work #: (____)__________________________

E-mail ______________________________________________________________________

Signature______________________________________________________________

Owner: (If same as driver just mark "Same")

SSN/Fed ID: ________________________ Date of Birth: ________/_______/_______

Name /Company Name:____________________________________________________

Address: ________________________________City, State, Zip: ______________________

Home #: (___)________________________Work #: (____)____________________________

Email_______________________________________________________________________

Signature____________________________________________________________________

Sponsors: (for program):___________________________________________________

Other:_______________________________________________________________________

I will abide by the rules of Colorado 1200 Outlaws as listed in the 2014 rulebook for this racing season.  I will not hold the Colorado 1200 Outlaws, its director, or any potential track officials responsible for any physical injury or damage to my vehicle (s).

I understand a breathalyzer test may be required at any time.  I understand refusal to take the test or failure of the breathalyzer test will result in disqualification with no pay or points.

____________________________________   _____________________________________

(Participant)                                                                           (Director)

Make check/money order payable to Colo. 1200 Outlaws 18245 E. Hwy. 94 Colo. Springs, CO 80930

 

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