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| Southwest
Supermoto.COM Night GP |
Transponder
No: |
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| Driver Information |
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| Driver Name:
_____________________________________________ |
Age:______________ |
DOB:_______________ |
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| Address:_________________________________________________ |
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| City:_____________________________________________________ |
State:_____________ |
Zip:________________ |
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| Day Phone:_______________ |
Eve Phone:___________________ |
Email:_________________________________ |
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*Needed
for email confirmation of your race entry. |
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| Emergency Information |
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| Contact
Person:__________________________________________ |
Phone:________________________________ |
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| Health Insurance
Provider:_________________________________________________________________________ |
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| Allergies:________________________________________________ |
Blood
Type:____________________________ |
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| Race Entry Information: |
Entry Fees
- Before 5/1/08: |
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| SuperMoto |
Mini Moto |
Pro Class - $100 (includes transponder and transponder bracket)
100% Payback |
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| Beginner |
Adult - Above 16
yrs |
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| Novice |
Junior |
First
Class/Endurance Team Race - $50 |
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| Amateur |
Pee Wee - 9 yrs
and Under |
Each
Additional Class - $30 |
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| Vet 20+ |
Endurance Team Race 1Hr. |
Mini Moto
Classes - $40 |
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| Vet 30+ |
Pro |
Additional
Mini Moto Class - $30 |
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| Vet 40+ |
Pro Open |
Entry Fees
- After 5/1/08: |
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| Sportsman
(Stock Wheels) |
Pro 450 |
Pro Class - $100 (includes transponder and transponder
bracket)100% Payback |
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| QUAD |
Pro 250 |
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| Pro |
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First
Class/Endurance Team Race - $60 |
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| Am |
Each
Additional Class - $40 |
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Mini Moto
Classes - $50 |
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| Machine:_______________________________________________ |
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Additional
Mini Moto Class - $40 |
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| CCs:___________________________________________________ |
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Race Number: |
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First
Class Bike #:_______________________ |
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| Payment Information: |
Second
Class Bike #:____________________ |
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Third Class Bike #:_______________________ |
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| Please Select: |
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Payment Total: |
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| Credit Card: ___________________________________________ |
Supermoto School |
x
$200.00 |
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| Expiration:
______/________ |
Billing Zip Code:_______________ |
Practice Fee |
x
$60.00 |
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Race Entry Fee |
x $ |
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| Signature: |
Additional Pit Passes |
x
$10.00 |
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Grand Total: |
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| X___________________________________________________ |
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| I
hereby authorize the following charges to be made to my credit card in
accordance with all applicable fees. |
THERE ARE NO REFUNDS ONCE YOU SIGN UP |
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| Tel:
520.245.5278 Fax
520.762.0557
www.p1kartcircuit.com
charlie@p1kartcircuit.com |
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| WARNING: Motorcycle racing is dangerous.
Each participant in competition has the responsibility to access the safety
aspects of the facilities and conditions and must assume the risk of
competition. |
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