The66EntryForm

2011 Pre-Entry Form Entry Fee: Optional Pit Reservation: Driver Information Name Date of Birth Address Phone Appt./Suite E-Mail City/State/Zip Car Number $150.00 $100.00 Owner Information Name Phone Address E-Mail Appt./Suite Chassis City/State/Zip Engine Make Sponsors (5 Max) Checks will be mailed to the car owner Mail: POWRi Racing Contact: Brad McDaniel 6157 Saxtown Rd. 618-303-9325 Millstadt, IL 62250 bmackn32@hotmail.com