Registration Form Race Date October 21 st Name
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- Please note that pre-registration ends October 18
- Checks to be made out to Atlanta Motor Speedway
2017 Atlanta Motorsports Park Pre-Registration Form Race Date – October 21st Name:________________________________________________________________________________ INEX #:_____________ Division (select one): □ Rookie Bando □ Bandits/Outlaws □ Young Lions/Semi-Pro □ Pro/Masters □Roadsters Car #: _______________ Car Color:___________________ Address: _____________________________________________________________________________ City: __________________________ State: _______________________ Zip: ______________________ Phone #: _________________________E-mail_______________________________________________
All spectator’s and crew are FREE. Please note that pre-registration ends October 18th at 5PM. Prices after October 18th at 5PM will be $125.00 for the Driver. If a driver chooses not to pre-register then they will start in the rear. Payment Info Visa / Master Card (circle one) # _____________________________________ Exp.______________ Credit Card CVV2 Code (3 digit code found on the back of card) __________ Zip Code: ____________ I authorize Atlanta Motor Speedway to charge my credit card listed above in the amount of $ _____________ Credit Card Authorized Signature: ______________________________________________________ Date: __________ Checks to be made out to Atlanta Motor Speedway Mail form to: P.O. Box 500 Hampton, GA 30228 Forms may also be faxed to 770-946-3945 or mailed to the address above attention Racing Radios Legends Championship. Payments are Non-Refundable and the rain date is December 2nd 
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