PLEASE PRINT CLEARLY & FILL OUT COMPLETELY

Name ___________________________________________________

Address__________________________________________________

City _________________________________State ____ Zip ________

( ) Check this box if you want to race for points in the championship racing series.

Car Names ______________________________ Sponsor ___________________________________

Body Year ________Make________Model________Engine Cubic Inch _____Engine Make ______

Driver’s License # __________________ NHRA Membership # ________________________

Someone who can be reached in case of emergency: Name _____________________________

Phone # ______________________________

ANNOUNCER INFORMATION Use the following space to list your accomplishments

(Race wins, Sponsors, etc.)

_____________________________________________________________________________________________

CIRCLE THE CLASS YOU WILL BE COMPETING IN (circle all that apply) (Shown in 1/8 mi. times)

SUPER PRO PRO SPORTSMAN MOTORCYCLE/SNOWMOBILE

(4.40-7.49) (4.50-8.59) (8.20-Slower) (4.50-slower)

Electronics No-Electronics No-Electronics No-Electronics

HIGH SCHOOL JUNIOR THUNDER JUNIOR LIGHTNING

(7.50-slower) (8 thru 12 years old) (13 years and older)

________________________________________________________________________________________

Driver must show NHRA Competition License or NHRA Competition Number card to verify NHRA number for ET Racing.

If you do not have a NHRA ET number, we will assign you a Madras Dragstrip number.

Mail completed from & $10 to: Madras Dragstrip, PO Box 617, Madras, OR 97741