Cost $25.00, entitles a $5.00 discount of pit pass at any
UMA track, Dells Raceway, Marshfield, State Park, Golden Sands.
Valid for card holder only.
PERSONAL INFORMATION
First Name: 
Last Name: 
Address: 
City: 
State: 
Zip: 
Phone: 
Email: 
Name on UMA Card: 
BILLING INFORMATION
Credit Card #: 
Exp Date (ex.02/17):   / 
Price:  $25
CLICK HERE FOR PRINTABLE VERSION TO MAIL IN


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