SAM SCIOTTI STREET STOCK SPECIAL
JULY 14, 2007

ENTRY $100 PER CAR
PLEASE PRINT: CAR#_______________DRIVER__________
MAILING ADDRESS____________________________________
CITY____________PROV._______POSTAL CODE___________
PHONE(____)________
CAR MAKE/MODEL/YEAR_____________________________
HOME TRACK________________________________________
MAJOR SPONSORS:
1)____________________________________________________
2)____________________________________________________
3)____________________________________________________
CAREER HIGHLIGHTS__________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________

PLEASE RETURN THIS ENTIRE SHEET WITH ALL ENTRY INFORMATION COMPLETED TO: AGASSIZ SPEEDWAY, BOX 9 AGASSIZ, BC V0M 1A0 (604)729-FAST(3278). E-MAIL:AGASSIZSPEEDWAY@TELUS.NET. TO PRE-ORDER TIRES PLEASE CALL ANDY BODNAR @ (604)796-9317