Mail Checks Payable To: F.M.S.A.
21103 Reindeer Rd.
Christmas, Fl 32709
www.flminisprints.com
PLEASE
PRE-ENTER IT HELPS F.M.S.A., and YOU WITH Registration Before the Races!
Reasons for Pre-Entry: Pre-Entry
Form Due by Feb. 21st. 2010 - (1st.
come 1st. serve on Guaranteed
Available Car #’s ), Track Pre-Entry
Totals, Announcer’s List, Programs Listing, FMSA Officials
Mailing Lists, Paid Officials, etc. All Entry
Fees Do Not Include Pit Gate Fee!
$30 Ea. Night Entry Fee with Completed
Entry Form- Pre-Entry Pays for 1st.Night of Competition,
can also pay for all nights of Competition
in advance.
Examples:
1-Night-$30 + Pit Gate Fee, 3-Nights-$ 90 + Pit Gate Fee
$40.00 Per Night if Pre-Entry Not Received before Feb. 21st
. 2010
1st. Available Car #: _______ 2nd. Available Car #: _________
Name:
__________________________________________________Address:
_____________________________
City, State, Zip Code:
_______________________________________________
Engine Mfg. _____________ Circle One:
600-619cc / 636-750cc Chassis Mfg.
________________
Sponsors: _________________________________________
Achievements: ____________________________________
S.S.N.: _______-_____-_______
PH.#:(_______) _______-_________ EMAIL: ____________________@________________
In Case of Emergency
Contact:
__________________________________________________
Blood Type: _________________________
Allergies: _____________________
Injury Release
I agree that when I participate in any
Florida Mini Sprint Association event or function, I do so at my own risk and
that
Florida Mini Sprint Association,
officers, members, crew, participants or tracks are not responsible for my
safety of bodily injury or any damage to
property belonging to myself.
Signed: ___________________________________ Date: ___-___- 20___
-----------------------------------------------------For F.M.S.A. Office
Use Only --------------------------------------------------------------------------------------------------------------------------
Date Received Form: ________ Approved Car #: ________
Pre-Paid Entry-$30.00 Circle
Ea.Date: 2/25,2/26,2/27 -
Post-Paid Entry-$40.00- Circle
Ea.Date: 2/25,2/26,2/27 -
-----------------------------------------------------For F.M.S.A.
Tech Inspection Use Only ------------------------------------------------------------------------------------
Circle One: 600-619cc /
636-750cc - Passed Pre-Inspection- Circle Ea.Date:
2/25,2/26,2/27 -
Top (6) Finishing Positions- Passed Post-Inspection- FMSA Tech Initials:______
2/25- Heat #____ Pos.#____ Feature
A/B Pos.#_____ 2/26- Heat #____ Pos.#____ Feature A/B Pos.#_____ 2/27 -
Heat #____ Pos.#____ Feature A/B Pos.#_____
cc’s :_______ Stoke:________