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Driver: (Please
Print Legibly)
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
2024
rulebook for this racing season. I will not hold C.R.A., its promoter, the City
of Pueblo and/or Pueblo Parks, 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 80930-9418
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