El Paso County Speedway Registration Form

Owner $75.00 Owner/Driver $90.00 Driver $25.00

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______________________________________________________________________

Classification of Car: (circle one)

1200 Outlaw Modified Stock Car Hobby Truck Hornet ATV Outlaw Micro Sprint

Car #: 1st Choice_____________2nd Choice ______________3rd Choice________________

Sponsors: Main Sponsor (for program):___________________________________________

Other sponsors: __________________________________________________________________________

I will abide by the rules of El Paso County Speedway as listed in the 2007 rulebook for this racing season. I will not hold El Paso County Speedway, its promoters, or any 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) (Promoter)

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