One Form per Driver - please use additional form(s) if entering more than one class per day

DRIVER INFORMATION

Name

Address

City, State, Zip

Phone Number(s)

E-mail Address

DOB (Reqd.)

(driver's license, birth certificate, or other proof of age required at registration)

(minor's consent form must be completed for any driver under age 18)

CLASS REGISTRATION

For Registration

RACING CLASS

KART # Preferences

$ AMOUNT

Use Only

Practice - 12/27

YES

NO

1st

2nd

3rd

$ -

Day 1 - 12/28

$ -

Day 2 - 12/29

$ -

Day 3 - 12/30

$ -

Day 4- 12/31

$ -

Enter class in above blanks - Practice day fee - $30 per driver (includes driver's pit pass, and fuel)

Pre-entry fee - $60.00 per class MUST BE RECEIVED BY Dec. 1st (includes driver's pit pass, fuel, and transponder)

Entry fee - $80.00 per class IF RECEIVED AFTER Dec. 1st (includes driver's pit pass, fuel, and transponder)

! ! KAHUNA DAY DISCOUNT ! !

Racers entering all 4 race days receive a $30 discount for the Kahuna Race on Day 4

$ -

RESERVED PIT SPACES

$75/event or $20/day

# of pit spaces

$ AMOUNT

(see pit map for more info)

Pit Spot Preferences

Full Event

$ -

1st

Day 1 - 12/28

$ -

2nd

Day 2 - 12/29

$ -

Group Name (if applicable)

3rd

Day 3 - 12/30

$ -

4th

Day 4 - 12/31

$ -

All pit spaces must have at least a 5' X 7' ground tarp for working area to prevent spills

ADDITIONAL PIT PASSES

$ AMOUNT

number of adult EVENT pit passes @ $40 each

$ -

number of child (under 5) EVENT pits passes @ $20 each

$ -

number of adult DAILY pit passes @ $10 each

$ -

number of child (under 5) DAILY pit passes @ $5 each

$ -

Pit passes (wristbands) are required for each race day and practice day

LAST DETAILS

Transponder brackets (1 required per kart)

@ $5

$ -

HOLIDAY CLASSIC EVENT TOTAL

TOTAL

$ -

50% DEPOSIT REQUIRED AT TIME OF PRE-ENTRY

$ -

BALANCE OF PAYMENT DUE AT SIGN-IN

$ -

RETURN REGISTRATION FORMS AND CHECKS

AKA HOLIDAY CLASSIC

mr

PAYABLE TO:

PO BOX 556

bc

WADDELL, AZ 85355