Registration Forms

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2017MISDriverentryform.pdf

Click on PDF tab on top right, then print out the pdf file.  Fill it in and send to track.

2017 Driver Registration Form

Mobile International Raceway, Inc.  welcomes you to Mobile International Speedway.  We want to thank you in advance for being a part of our program.  Please fill out the information below as thoroughly as possible. This information is for our accounting records and will be used to promote you at our events.

Driver ___________________________________________ Class ________________ Car# _____________

Street ________________________________City _____________________ ST ___ Zip __________DOB:__________________

Day Phone (_____)___________ Evening Phone (_____)__________S/S#______/_____/__  E-Mail        ________________    

 Owner:_________________________________________

Street ________________________________City _____________________ ST ___ Zip __________

Day Phone (_____)____________________ Evening Phone (_____)__________________

Make of Car _________________ Year__________ Model ____________SS#_____/____/_  __                                      E-Mail_________________________________________________________________________________________

Sponsors:

 

Years Racing/Classes and Tracks (Highlights):

 

Person receiving prize money (Name must match SS# )  Co. Name’s Must have Federal ID#

Name ___________________________________________________

Street ________________________________City _____________________ ST ___ Zip __________

Day Phone (_____)____________________ Evening Phone (_____)__________________

SS# ___________/__________/_________ OR Fed ID # __________________________________(Requires a Corp. Name)

ENTRY AND ADVERTISING RELEASE: In consideration of the awards of this event and the sanctioning of the event by Mobile International Speedway, the car owner and driver individually and jointly agree that          Gulf Coast Racing, LLC and it’s successors an/or assigns may use their name(s) and picture(s) of their person and car described herein, or any of them, in any way, medium or material for promoting, advertising, recording or reporting this event before, during and after such event, and do hereby relinquish all rights hereto for these purposes. This entry will not be accepted unless an invitation to compete has been paid and approved by Mobile International Raceway, Inc.

Driver and car owner understand this entry form covers all events in connection with Mobile International Speedway and that they understand and will abide by all rules, regulations and decisions as well as all stipulations in the entry blank Mobile International Speedway 2017 rules will apply.  Call the speedway at (251) 957-2026 for rules or further information. GOOD FAITH TO PUBLIC PLEDGE – In signing this entry blank, both driver(s) and car owner(s) recognize their obligation to the public and race promoter posting the prize money and conducting this event. Therefor we agree to compete in the event if humanly possible unless this event is postponed, cancelled or if the car fails to qualify for the starting field.

Submitted for approval by:_____________________________________________ Date ____/____/____

                                          (Signature)                                                                                                Miller Lite Series Entry Fee is $125.00 Late Entry Fee is $150.00 Pro Late Model 100 Lap Entry Fee is $100.00 Make checks payable to: Mobile International Speedway ANYONE UNDER 19 YEARS OF AGE MUST HAVE A PARENT OR LEGAL GUARDIAN SIGN A MINOR RELEASE FORM TO ENTER PIT.  (A DRIVER UNDER 18 YEARS OF AGE MUST HAVE A PARENT OR LEGAL GUARDIAN’S ON MINOR RELEASE FORM NO EXCEPTIONS. 

                                                      WWW.MOBILESPEEDWAY.NET    

 

 

 

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