CAROLINA MOTORSPORTS PARK, INC.

Mailing Addr: PO Box 366, Kershaw, SC 29067 / Shipping Addr: 3662 Kershaw Hwy, Kershaw, SC 29067

803-475-2448 / Fax# 803-475-3303

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CMP TEST DAY REGISTRATION FORM

$225-PER CAR

REGISTER ONE WEEK PRIOR TO THE TEST DAY FOR $190 PER CAR

                                                                                                                           

TEST DATE:________________________________

NAME:_______________________________________________ 

STREET: ___________________________________________________

CITY:_______________________________  STATE:_______________

ZIP CODE:_____________

PHONE: (DAY)____________________________  (NIGHT):__________________   (FAX#):_________________________

PERSON & PHONE# TO CONTRACT IN CASE OF EMERGENCY:______________________________________

 

PLEASE READ AND SIGN: I hereby certify that I have no known physical or medical problems that might jeopardize others or myself if I participate in this event.   _________________________________________                             

(Driveršs signature required)

DRIVER & CAR INFORMATION

 

LIST RACE LICENSE & NUMBER(s):___________________________

                                                  (Racing License REQUIRED)          

RUN GROUPS-please circle one     Under 3 liters, Over 3 liters, Open Wheel

 

CAR NO# _______   COLOR ______________  MAKE ___________  MODEL________

CAR NO# _______   COLOR ______________  MAKE ___________  MODEL________    

 NOTE: THERE WILL NOT BE A STREET CAR GROUP FOR TEST DAYS PRIOR TO RACE            WEEKENDS              

ADDITIONAL DRIVERS/CAR INFORMATION

 

ADDITIONAL DRIVER NAME:________________________________

LICENSE # & TYPE:_________________

PLEASE READ AND SIGN: I hereby certify that I have no known physical or medical problems that might jeopardize others or myself if I participate in this event.   _________________________________________  

(Driveršs signature is required)

 
TOTAL NO# OF DRIVERS:__________  NO# OF CARS __­­__________

 

CREDIT CARD (VISA/MC ONLY) NAME OF CARD: ______________________

CARD#: ____________________________________      CVV*#_________________

EXP DATE: ____________________ 

BILLING ADDRESS: _____________________________________________________________

 

  AMOUNT PAID $_____________  CHECK #_______________

Please make check payable to: CAROLINA MOTORSPORTS PARK, Inc.

WE ACCEPT CREDIT CARDS

Send registration form & check to: CMP ­ PO Box 366, Kershaw, SC 29067

Gates & Registration open at 7am / Drivers mandatory meeting at 8am

Track time 8:30am ­ 5:00pm/  3 to 4 Run Groups with 20-minute sessions

 

 

 

* 3 Digit Security Code  on the back on your credit card