Drivers Name___________________Car #____

Division___________________________

Drivers Address_____________________

_________________________________

Drivers Phone #_____________________

Drivers SS#________________________

Drivers License #____________________

Date of Birth_______________________

 Person Responsible for Car’s Earnings

Name_____________________________

Address___________________________

_________________________________

Phone #___________________________

SS#/Fed ID#______________________

 Sign_________________________Date__________

 By signing above I acknowledge that the above information is true and correct.  I grant permission for my name and photo to be used by Thunder Valley.  I have received and read a copy of Thunder Valley’s divisional and ground rules.  I agree that I am mentally and physically able to compete at Thunder Valley.