Personal Information

Driver's Name
Driver's Birth Date
Team Manager
Address
City
State / Zip	/
Phone
E-mail
Transponder # (if you own one) "ON FILE" IS NOT A NUMBER!
Credit Card Number (VISA, MASTERCARD or DISCOVER) NO AMEX!
Expiration Date
CCV Three Digit Security Code on Back of Card
VERY IMPORTANT! Please give your desired kart number	- 1st choice - 2nd choice

Event Information (check all applicable boxes)

Race Date and Race Number (Pre-Entrys Must be Received two days before the Event!)	Sat/Sun October 13-14
Class Entry PLEASE SELECT CLASS!(check box & select class) (DOES NOT INCLUDE PIT PASS!)
$200.00 Please select class Yamaha Junior Sportsman Yamaha Junior
Transponder Rental ($10.70 per driver)	Please make selection No Transponder Needed 1 Transponder Rental - $10.70
Two Day Pitpass Driver and/or Crew, You can also wait to buy your pit passes at NCMP	Please make selection None, Will Purchase at NCMP 1 pass - $18 2 passes - $36 3 passes - $54 4 passes - $72