Car #: 1st Choice_____________2nd Choice ______________3rd Choice________________

Social Security number: _______-_____-_______ Date of Birth: ______/______/______

Driver Name: __________________________________________________________________

Address: ___________________________________________________City, State, Zip: _______________________________

Home #: (____)__________________ Work #: (____)_______________________E-mail _______________________________

Signature_________________________________________________________________________________

Owner: (If same as driver just mark "Same")

SSN/Fed ID: ________________________ Date of Birth: ________/_______/_______

Name /Company Name:__________________________________________________________

Address: _______________________________________________City, State, Zip: ____________________________

Home #: (___)____________________________________ Work #: (____)______________________________________

Email__________________________________________________________________________

Signature______________________________________________________________________

Sponsors: Main (for program):_______________________________________________________________________

Other: __________________________________________________________________________________________________

I will abide by the rules of C.R.A. as listed in the 2019 rulebook for this racing season. I will not hold C.R.A., its promoter, the City of Pueblo, or any track officials responsible for any physical injury or damage to my vehicle(s).

I understand a breathalyzer test may be required at any time. I understand refusal to take the test or failure of the breathalyzer test will result in disqualification with no pay or points.

________________________________________________ _________________________________________________

(Participant) (Promoter)

Make check/money order payable to C.R.A. 18245 E. Hwy. 94 Colo. Springs, CO 80930