Alive for Five #4
Badger State 125


If your planning on racing this event please sign up early
so we can advertise your coming, its good for you, your sponsor, and us.

All tires must be purchased at track.
PERSONAL INFORMATION
Driver Name: 
Phone: 
Address: 
City: 
State: 
Zip: 
Email Address: 
Car #: 
Make & Model: 
Car Colors: 
Main Sponsors: 
Racing Accomplishments: 
SEND 1099 INCOME TAX FORM TO
Send To:   Driver    Business    Owner  
SSN or FEIN#: 
Owner/Business Name: 
Owner/Business Address: 
Owner/Business City: 
Owner/Business State: 
Owner/Business Zip: 
ENTRY FEE:  $125 ($150 on Race Day)
BILLING INFORMATION
NAME ON CARD: 
CC NUMBER: 
EXP DATE:   / 
CVV2 (Code on Back): 



N1070 Smith Rd.   Wisconsin Dells, WI 53965    Phone: 608-253-7223