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90 HANOVER STREET NEWBURY, MA 01951 OFFICE NO: 978-462-4252 2008 DRIVER’S REGISTRATION FORM - LOWER DIVISIONS: FEE: $50.00PAYOFF INFORMATION: Information must be completed for payoff check. Legal Name on Payoff check:____________________________________________________
Social Security # ________- ________ - ______Or Tax I.D#_________________________
OWNER’S INFORMATION: PLEASE PRINT Owner’s Name: ______________________________________________________________ Address: _____________________________________________________________________City:_________________________________ State:___________ Zip:__________________ Evening#:___________________________ Daytime Phone #: ________________________ S.S.#:______-____-______D.O.B.:________________Nascar#_________________________ Occupation_________________________ Chief Mechanic_________________________ DRIVER’S INFORMATION: PLEASE PRINT Driver’s Name:________________________________________________________________ Address:______________________________________________________________________ City:__________________________________State:___________ Zip:___________________ Evening:Phone#:______________________ Daytime Phone #:_________________________ S.S. #:____-___-_____ Nascar Lic. #:___________________D.O.B. ____________________ Occupation__________________ Major Sponsor: ___________________________ CAR INFORMATION: Division: Circle one: Late Model Sportsman Hobby Stock Road Runner Ironman Division Make & Model:___________________ Year:__________ Car #:______________________DRIVER AND OWNER PARTICIPATION IS REQUIRED IN THE ANNUAL LEE USA SPEEDWAY BANQUET OF CHAMPIONS. THE TOP 10 TEAMS IN EACH DIVISION ARE REQUIRED TO ATTEND, FAILURE TO ATTEND THE BANQUET WILL RESULT IN THE LOSS OF ALL LEE & NASCAR POINT FUND MONEY AND AWARDS, PLUS ANY SPECIAL SERIES AWARDS. A CURRENT NASCAR LICENSE IS REQUIRED FOR ANY DRIVER AND OWNER TO RECEIVE LEE & NASCAR POINT FUND MONEY. THE UNDERSIGNED DRIVER AND CAR OWNER AGREE TO ATTEND THE ANNUAL LEE USA SPEEDWAY BANQUET OF CHAMPIONS. NO ONE ELSE CAN PICK UP YOUR TROPHY AND AWARDS AT THE BANQUET.
Driver’s Signature__________________________________________________Date_________________________________
Owner’s Signature__________________________________________________Date_________________________________
OFFICE USE ONLY: Amount Paid: ____________ Check #: ______________________
Date Paid: ______________ Received by: ______________ Approved: ________________________________ |