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2014 RoboPong 200 Presented by Bridgestone Entry Form September 19th-21st 2014

Team Information

Team Name
Team Manager (person to contact for questions)
Driver's Name (maximum 4 drivers)
Co Driver's Name
Co Driver's Name
Co Driver's Name
Chassis Brand
Engine Type
Address
 
City
State / Zip   /
Daytime Phone of Team Manager
E-mail of Team Manager
Transponder # (if you own one)
Credit Card Number
(VISA, MC, DISCOVER) NO AMEX!
Expiration Number
CCV Three Digit Security
Code on Back of Card
(VISA, MASTERCARD or DISCOVER)
VERY IMPORTANT!
All numbers must be 1 or 2 or 3 digits - No letters allowed!
Please give your desired kart number
- 1st choice
- 2nd choice

Event Information (check all applicable boxes)

Race Date

Entries received after 9/5/14 will be charged a $50.00 late fee
Class Entry (check box)
(
DOES NOT INCLUDE PIT PASS!)

$564.00 Entry Includes 1 set of YLC tires (includes sales tax)

Transponder Rental
(
$10.70 per team)
Two Day Pitpass
Driver and/or Crew
You can also wait to buy your pit passes at NCMP

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