SUPER LATE MODEL ENTRY FORM
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: 
BILLING INFORMATION
CAR CLASS: 
NAME ON CARD: 
CC NUMBER: 
EXP DATE:   / 
PIT SLAB ASSIGNMENT
PIT SLAB:   [Reference Chart of Pit Slabs]
Semis only allowed 90-101






Racer Entry Fees:
Pit Slab included
Super Late Model: $100


PIT PASSES:
Saturday: $20
Sunday: $35
Two Day: $50
N1070 Smith Rd.   Wisconsin Dells, WI 53965    Phone: 608-253-7223