2021 Modified Plow Boy Nationals Registration Form

Here is the 2021 Modified Blow Boy Registration Form

Please Make Checks Payable To ----    
 
Race Date Sun 9/5/21                                              
                                                                     
Spoon River Speedway Plow Boy Modified Nationals Pre-Registration Due by Aug 28th
                                                                     
                 $100.00          (Late Entry after Aug 28th $125.00)
                                                                     
This Includes Driver, Car and Transponder
                                                                     
DRIVER - Car #
                                                                     
STREET-     CITY -----
                                                                     
STATE --   ZIP E-MAIL
                                                                   
Ph [ ]                -   AGE   S.S. # ----                  -                  -
                                     
                                                                   
PARENT OR GUARDIAN IF DRIVER IS UNDER THE AGE OF 18
                                                                     
NAME --- PHONE [ ]                -    
                                                         
CAR OWNER'S NAME -- Enter -- SAME -- If As Above
                                                                     
NAME --- PHONE [ ]                -    
                                                         
STREET    CITY   STATE -
                                                                     
        ZIP       Social Security # -      -                 -             
                                                   
    Upon completion of this Pre-registration,  
       I agree that I have read and understand the rules, regulations, and race procedures and will abide by them.
I hereby agree that Spoon River Speedway, it's licenses, successors, and assigns shall have the right to use the
name, photographs, or other likenesses, in the connection with or for the purpose of publicizing, and exploting,
[including other commercial and or trade purposes] Spoon River Speedway
IF SOCIAL SECURITY NUMBERS & INFORMATION ARE NOT TURNED IN CORRECTLY
RACERS PAY CHECKS WILL BE HELD UNTIL FORMS ARE COMPLETED PROPERLY
                                                                     
  Signature --   Date -    
                                                                     
Must be received NO Later than August 28th to:   Spoon River Speedway   C/O Morey Denney
                                                                                                    19776 N. Mellert RD
                                                                                                      Canton, Ill    61520
If races are a complete rain out with NO makeup date, money will be returned to address provided.