Lee Fields 150

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Click to link below for PDF copy of registration.

SSSEntryFormMisLEEFIELDSMEMORIAL

 

Click below for MS word version

SSSEntryFormMisLEEFIELDSMEMORIAL

 

 

Track: Mobile International Speedway                          Race Date: Aug 20, 2016           

Location: Mobile, AL         Division: Southern Super Series

Race Start: See Attached Schedule                               Distance: 150Laps                                                                                         Fuel: Sunoco 110 from (15 gal Min. purchase)          Promoter: MIS & SSS

Tires: Hoosier F-45 (Impounded/6 TIRE MAX FOR RACE.)

PURSE: $6000 TO Win; $500 to Start; FAST QUALIFIER AWARD $500

DRIVER_______________________________________________________________             CAR #_______________

 SOCIAL SECURITY #_______-______-_______ E-MAIL______________________

PH (____)____________DOB______ 

ADDRESS________________________________CITY__________________________

ST________________

 CAR OWNER_________________________ADDRESS__________________________ST______ZIP_______________

 EMERGENCY CONTACT___________________________________

 PERSON RECEIVING PRIZE MONEY_____________________ADDRESS____________________________________ 

SS # or FED I.D. __________________________________________________________________________________

 DRIVER SIGNATURE_______________________________________

 SPONSORS_______________________________________________________________________________________

 Entry Fee: $125.00 Late Entry Fee: $150.00

Please Make all checks payable to: Southern Super Series, LLC

Please send all checks to: Southern Super Series 7451 Pine Forest Rd. Pensacola, FL 32526   Ph (850)-944-8400 Fax (850)-944-8409

ENTRY AND ADVERTISING RELEASE: The undersigned understands and agrees that their name and likeness may be used by Southern Super Series (SSS) and authorized agents in any way, medium, or material to promote, advertise, record, or report this event before, during, and after the event, and do hereby relinquish all rights hereto for these purposes. The undersigned understands and agrees that all decisions made by SSS Officials will be final and without recourse. In the event that this application is terminated, it shall be without restitution of any part of the fee paid with this entry and further, waives any and all rights or claims to any bonus money due to or resulting from racing efforts with SSS prior to SSS termination. The undersigned further waives any and all rights for themselves, their agents and assigns, to institute any action, suits or proceedings, whether at law, or any other action against SSS and its officers, directors, agents and employees for any and all, manner or actions, cause and causes of actions, suits, damages, and claims that the undersigned and their heirs, successors, assignees may have now, or at any time in the future may have, arising in any manner from SSS promoted events, excepting SSS obligation to pay purses, bonuses, and awards as set forth in the Official entry form for SSS promoted events. The undersigned understands and agrees that this constitutes a wavier of any and all claims for personal injury, breach of contract, and any other loss of damage except as expressly provided herein.

 

 

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