2010 Cedar County
Raceway Registration
Track Registration $40 $30 if paid by March 15th
(PIT PASSES WILL BE $10 MORE PER WEEK WITHOUT
REGISTRATION)
DRIVER NAME:______________________________ CLASS:_____________
SOCIAL SECURITY #: __________________________
ADDRESS:__________________________________
CITY:______________________ STATE:_________ ZIP:__________
(PLEASE INCLUDE E-MAIL
/ CELL PHONE TO RECEIVE CANCELATIONS & IMPORTANT INFO.)
PHONE:____________________
E-MAIL_____________________________
PERSON OR BUSINESS TO RECEIVE FEDERAL 1099 TAX FORM
MAKE CHECKS PAYABLE TO:_______________________________________
SS# OR FEDERAL ID# (MUST MATCH CHECKS PAYABLE TO)_______________________
ADDRESS:____________________________________
CITY:____________________
STATE:_______ ZIP:____________
PHONE:_________________________
E-MAIL_____________________________
DRIVER SIGNATURE:______________________
DATE:_______________
OWNER SIGNATURE:______________________
DATE:_______________
IF SENDING BY MAIL:
PLEASE MAKE CHECK
PAYABLE TO: CEDAR COUNTY RACEWAY
MAIL TO: 212 EAST 7th
ST. TIPTON, IA 52772
FOR OFFICE USE
ONLY: RECEIVED BY:________
DATE PAID:________ AMOUNT_________