DRIVER INFORMATION
Driver Name:
Age:
Date of Birth:
Address:
City
State Zip
Email Address
Daytime/Cell Phone #
Evening/ Home Phone #

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Emergency Contact Information
Contact Person
Relation
Phone #
Alternate Phone #
Allergies or Medical Conditions
Is person here today:    
YES
NO

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Race Information
Choose Race Date
Feb 16
Mar 23
April 27
May 11
June 22
Aug 24
Sep 14
Oct 19
Nov 16
Dec 7

Choose Class
Kid Karts Junior Clone 1 Junior Clone 2 Clone Senior Open Shifter Class
 
Yamaha Sportsman Yamaha Junior Yamaha Supercan Micro Max
 
 Mini Max Junior Max Senior Max Rotax Masters
Rotax DD2 TAG International

Entry Fees & Payment Information

Entry Fees                    
First Race Class $55
(Includes Pit Pass)
Second Race Class - $40
Kid Karts - $30
(Includes Pit Pass)
Friday Practice - $50

Additional Pit Passes - $5 each per day - (choose amount below)
1 2 3 4 5 6 7 8 9 10

Transponder Rental $15
Transponder #
Kart Number #
Rotax Member #

Credit Card Information
Name on Credit Card
Card #
Exp Date
CVV #
Type:
Visa
MasterCard
American Experss
Discover Card
 
Billing address if different from above
Address:
City
State Zip

Contact Info:  sylvia@carolinamotorsportspark.com
Phone:  803-475-5006   Fax: 803-475-3303                         Address:   P.O. Box 366      Kershaw, SC 29067