Entry Form for Allen Turner PLM 100 Race
Track: Five Flags Speedway Race Date: April 26, 2019 Location: Pensacola, Division: Allen Turner Challenge Series Race Start: See Attached Schedule Distance: 100 Laps Fuel: Sunoco 110 from (10 gal Min. purchase) Promoter: Bryant Motorsports, L.L.C. Tires: Hoosier F-45 (Impounded/4 TIRE MAX FOR RACE.)
DRIVER_______________________________________________________________ CAR #_______________
SOCIAL SECURITY #_______-______-_______ E-MAIL______________________ PH (____)____________DOB______
ADDRESS________________________________CITY__________________________ST______ ZIP_______________
CAR OWNER_________________________ADDRESS_______________________CITY________________ST_______
ZIP_______________
EMERGENCY CONTACT___________________________________
PERSON RECEIVING PRIZE MONEY_____________________ SS # or FED I.D. __________________________
ADDRESS __________________________ CITY__________________________ST______ZIP_______________
DRIVER SIGNATURE_______________________________________
SPONSORS_______________________________________________________________________________________
Early Entry Fee: $100.00 Late Entry $125.00
Please Make all checks payable to: Five Flags Speedway
Please send all checks to: Five Flags Speedway 7451 Pine Forest Rd. Pensacola, FL 32526 Phone (850)-944-8400 Fax (850)-944-8409
ENTRY AND ADVERTISING RELEASE: The undersigned understands and agrees that their name and likeness may be used by Five Flags Speedway and authorized agents in any way, medium, or material to promote, advertise, record, or report this event before, during, and after the event, and do hereby relinquish all rights hereto for these purposes. The undersigned understands and agrees that all decisions made by FFS Officials will be final and without recourse. In the event that this application is terminated, it shall be without restitution of any part of the fee paid with this entry and further, waives any and all rights or claims to any bonus money due to or resulting from racing efforts with FFS prior to FFS termination. The undersigned further waives any and all rights for themselves, their agents and assigns, to institute any action, suits or proceedings, whether at law, or any other action against FFS and its officers, directors, agents and employees for any and all, manner or actions, cause and causes of actions, suits, damages, and claims that the undersigned and their heirs, successors, assignees may have now, or at any time in the future may have, arising in any manner from FFS promoted events, excepting FFS obligation to pay purses, bonuses, and awards as set forth in the Official entry form for FFS promoted events. The undersigned understands and agrees that this constitutes a waiver of any and all claims for personal injury, breach of contract, and any other loss of damage except as expressly provided herein.
| Track: Five Flags Speedway Race Date: April 26, 2019 Location: Pensacola, FL Division: Allen Turner Challenge Series Race Start: See Attached Schedule Distance: 100 Laps Fuel: Sunoco 110 from (10 gal Min. purchase) Promoter: Bryant Motorsports, L.L.C. Tires: Hoosier F-45 (Impounded/4 TIRE MAX FOR RACE.)DRIVER_______________________________________________________________ CAR #_______________
SOCIAL SECURITY #_______-______-_______ E-MAIL______________________PH (____)____________DOB______ ADDRESS________________________________CITY__________________________ST______ZIP_______________ CAR OWNER_________________________ADDRESS_______________________CITY________________ST_______ ZIP_______________ EMERGENCY CONTACT___________________________________ PERSON RECEIVING PRIZE MONEY_____________________ SS # or FED I.D. __________________________ ADDRESS __________________________ CITY__________________________ST______ZIP_______________ DRIVER SIGNATURE_______________________________________ SPONSORS_______________________________________________________________________________________ Early Entry Fee: $100.00 Late Entry $125.00 |