2008 ET POINTS PROGRAM REGISTRATION FORM

 

(PLEASE PRINT CLEARLY & FILL OUT COMPLETELY- INCOMPLETE FORMS WILL BE RETURNED)

 

NAME:                                  ________________________________________________________________

 

MAILING ADDRESS:        ________________________________________________________________

 

CITY, STATE & ZIP :          _________________________________________________________________

 

SOCIAL SECURITY:          _________________________________________________________________

                                               (REQUIRED OF ALL RACERS INCLUDING JUNIOR DRAGSTERS)

 

PHONE: (_________)  _________-_____________  May we release this to other racers?     Y        N

 

EMAIL:  ___________________________________May we release this to other racers?     Y        N

 

ADULT JACKET SIZE:    S      M      L     XL     2XL    3XL

 

ADULT SHIRT SIZE:           S      M     L     XL     2XL     3XL

 

CAR/BIKE     ___________________           ____________________________     ____________________

                      Make                                         Model                                                   Year

 

NHRA Competition # _____________            Expiration Date: ____________________

 

NHRA Membership # _____________           Expiration Date: ____________________

If the above is not complete- it will be assumed you do not have an NHRA assigned competition number and/or are not a member of NHRA. This information is critical for Bracket Finals. Racers MUST have a valid NHRA Membership to compete at the Bracket Finals.

 

Lebanon Valley Competition Number (if one was previously assigned and if different than NHRA Competition Number) _________

 

RACE CLASS & MEMBERSHIP FEES (PLEASE CHECK APPROPRIATE BOX)

 

 

SUPER  - $80

 

  JUNIOR MAJOR - $50

 

PRO -  $80

 

  JUNIOR INTERMEDIATE - $50

 

BIKE - $80

 

 

 

STREET SERIES  - $50

 

  HIGH SCHOOL – $30

 

CASH:  ____________                     CHECK: ____________                  CREDIT/DEBIT CARD: __________   

 

Received: ______________