Untitled Document

	Fill out one form for each class
Last Name		First Name
Address		Email
City		State
Zip		PVR #
Phone #		DOB
Sled Brand		Sled Model
Sled Year		Engine Cooling Type
Engine Make		Engine Displacement
71 & Older Relic Mod F/A		85 & Older Juniors
73 & Older Mod Stock F/A		85 & Older Masters F/A
73 & Older Pro Mod F/A		73 & Older Women's Single Pro Mod Fan
85 & Older Pure Stock		82 & Older IFS Classes
85 & Older Super Stock F/A		82 & Older IFS X Classes
85 & Older Super Stock L/C		Cup Race
85 & Older Super Stock Fan
85 & Older Super Mod F/A
85 & Older Super Mod L/C			Choose Entry Fee Below: One Entry Per Form
	Insurance $10.00 Per Day		$20.00 + Insurance $30.00 $30.00 + Insurance $40.00 $20.00 Paid insurance on previous entry $30.00 Paid Insurance on previous entry
Pit Pass-Entry Inclues driver and 1 pit person
Payment Information	Registered online will pay day of race Register day of race (I understand it will cost $10.00 per class more)		Lily Registration Closes January 13 Mole Lake Registration Closes Feb 1 LaCrosse Registration Closes Feb 15 Lake Holcombe Closes February 23
Mail Payment to:	Pro Vintage Racing 1324 County Road J River Falls, WI 54022		Current Membership Form Required Membership Waiver Required Race Waiver Required for anyone entering Pit area

	We are now online and working. I will send a confrimation the following day for all race entries via email. Thanks Joann	Total Amount Enclosed

Fill out one form for each class