2010 GATOR MOTORPLEX and 105 MOTOR SPEEDWAY

REGISTRATION FORM:

THE 2010 REGISTRATION FEE IS $25.00 PER RACE TRACK.

PLEASE CHECK ONE OR BOTH TRACKS THAT YOU ARE REGISTERING FOR:

____ GATOR MOTORPLEX $25 (enclosed)

____ 105 MOTOR SPEEDWAY $25 (enclosed)

____ Both Race Tracks $50 (enclosed)

No personal checks. Send, Cashiers Check or Money Order Payable to & Mail to:

Gator Motorplex – 9521-E FM 1097 West – Willis, Texas 77318

or you may register at the track.

(circle a class of cars below)

LIMITED STREET HOBBY PURE MODIFIED

Car # _______

DRIVER'S NAME: ________________________ SS #________________

ADDRESS: __________________________________________

CITY: ____________________, TX ZIP: ______________

PHONE: (_______) ________- _______________ E-MAIL: ________________________________

ROOKIE: Yes No

CAR OWNER INFORMATION: (Complete Only If 1099 Misc. Tax Form Goes To Owner)

NAME: ________________________ SS #________________

ADDRESS: __________________________________________

CITY: ____________________, TX ZIP: ______________

PHONE: (_______) ________- _______________

SPONSOR INFORMATION: (OPTIONAL)

_______________________________________________________________________________

By completing this information you are responsible for reading track general rules and class rules. The above information will be used for 1099 information in the event you earn $600 or more.