Entry Form for Aftermarket Nationals June 29,30 & July 1 at the Farley Speedway.
Practice will be June 29.
Racing the 2 other days.

Driver Name________________________________
SS#_____________________DOB_______________
Address ___________________________________
City______________________St__________ZIP______
Phone ____________________Cell______________________
If pre registerd by June 24, 2016 the entry fee is $50 for IMCA Sport Mod and $100 for IMCA Mod. (After June 24 entry fee will be $150 for IMCA Mod and $100 for sport mods)
REMINDER: No Crate Engines
Division( circle one) IMCA Sport Mod IMCA Modified
Car #______________
Engine Builders Company Name______________________________________________________
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PRIZE MONEY GOES TO (person or business the Federal 1099 will go to )
Name or Business Name________________________________
Federal ID# or SS#_______________________
Address___________________________________
City___________________St__________Zip__________
Phone #_________________________cell#_________________________