ENTRY FORM FOR RACERS RUMBLE IV   _              ______                                                         

Driver ______________________________________________ Car # ______ Class ________________

S.S.# _______ - ____ - _______ 

Address _______________________________________ City ______________ State ______ Zip _______

Phone (____)_____-___________

1099 Info if Different from above 

Owner _________________________________________

S.S.# ________-____-__________ 

Address ________________________________________ City _____________ State ______ Zip_______  

You Must Pre-enter – $50 Car Entry Fee Through Sept.20^TH 

LATE ENTRY FEE $75 ENFORCED

Mail to: Galesburg Speedway 913 Ely Street - Allegan, MI 49010

DRIVERS MAY RUN MORE THAN ONE CLASS

MUST PAY REGISTRATION FOR EACH CLASS RUN

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