CAROLINA MOTORSPORTS PARK, INC.

Mailing Addr: PO Box 366, Kershaw, SC 29067 / Shipping Addr: 3662 Kershaw Hwy, Kershaw, SC 29067

803-475-2448 / Fax# 803-475-3303

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CMP TEST DAY REGISTRATION FORM

$225-PER CAR

REGISTER ONE WEEK PRIOR TO THE TEST DAY FOR $190 PER CAR

TEST DATE:________________________________

NAME:_______________________________________________

STREET: ___________________________________________________

CITY:_______________________________ STATE:_______________

ZIP CODE:_____________

PHONE: (DAY)____________________________ (NIGHT):__________________ (FAX#):_________________________

PERSON & PHONE# TO CONTRACT IN CASE OF EMERGENCY:______________________________________

PLEASE READ AND SIGN: I hereby certify that I have no known physical or medical problems that might jeopardize others or myself if I participate in this event. _________________________________________

(Driver’s signature required)

DRIVER & CAR INFORMATION

LIST RACE LICENSE & NUMBER(s):___________________________

(Racing License REQUIRED)

RUN GROUPS-please circle one Under 3 liters, Over 3 liters, Open Wheel

CAR NO# _______ COLOR ______________ MAKE ___________ MODEL________

CAR NO# _______ COLOR ______________ MAKE ___________ MODEL________

NOTE: THERE WILL NOT BE A STREET CAR GROUP FOR TEST DAYS PRIOR TO RACE WEEKENDS

ADDITIONAL DRIVERS/CAR INFORMATION

ADDITIONAL DRIVER NAME:________________________________

LICENSE # & TYPE:_________________

PLEASE READ AND SIGN: I hereby certify that I have no known physical or medical problems that might jeopardize others or myself if I participate in this event. _________________________________________

(Driver’s signature is required)

TOTAL NO# OF DRIVERS:__________ NO# OF CARS ____________

CREDIT CARD (VISA/MC ONLY) NAME OF CARD: ______________________

CARD#: ____________________________________ CVV*#_________________

EXP DATE: ____________________

BILLING ADDRESS: _____________________________________________________________

AMOUNT PAID $_____________ CHECK #_______________

Please make check payable to: CAROLINA MOTORSPORTS PARK, Inc.

WE ACCEPT CREDIT CARDS

Send registration form & check to: CMP – PO Box 366, Kershaw, SC 29067

Gates & Registration open at 7am / Drivers mandatory meeting at 8am

Track time 8:30am – 5:00pm/ 3 to 4 Run Groups with 20-minute sessions

* 3 Digit Security Code on the back on your credit card