Racing Every Saturday Night Hot Laps at 6:30 Racing Action Starts at  7:30PM Sharp   Regular Admittance Prices Grandstand  7 & Under Free Ages 8 -13 $5.00 14 - Adult $10.00     Pit Entrance  $20.00

WAGNER SPEEDWAY

2010 Car & Number Registration

Driver

First Name:___________________________________________ Middle Initial: _____________

Last Name:______________________________ Address:______________________________________

Home Phone: ___________________________   City :_________________________________________

State:______________________ Zip:_______________________ DOB:_______________________

Email Address:______________________________________________

Social Security # or TAX ID #______________________________

Car #________________ Class:___________________ Points Fund Paid:______________

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Car Owner

First Name:___________________________________________ Middle Initial: _____________

Last Name:________________________________ Address:____________________________________

Home Phone: ___________________________   City :__________________________________________

State:______________________ Zip:_______________________ DOB:_______________________

Email Address:______________________________________________

Social Security # or TAX ID #______________________________

Sponsors:______________________________________________________________________________

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Accomplishments:________________________________________________________________________

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