AGASSIZ SPEEDWAY MEMBERSHIP 2008


First Name_________________________ Last Name_______________________

Address:___________________________________________________________

__________________________________________________________________

Phone Number: (Best)___________________ E-Mail:________________________ 

Drivers License#_______________________ Care Card#_____________________


Car # and Class__________      Sportsman / Street Stock / Mini Stock / Hornet / Midget       (circle one)


Car & Driver: $200.00     Youth (18 & younger) Car & Driver: $175.00       Individual: $60.00      (circle one)


Do you have any Medical Condition you would like us to be aware of? IE: Diabetes, Epilepsy, etc.:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________


Are you available for work parties and which days are best for you?____________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________


Are you aware of any potential advertising opportunities? IE your place of employment. Could you please include a contact name and phone number?___________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

What improvements would you like to see at the track? Please list in importance.__________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

Any suggestions?__________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
                        


 ***PLEASE MAKE CHEQUES PAYABLE TO KENT RACEWAYS SOCIETY***