Event: *
Name: *
Address: *

Phone Number: *

Kart Number: *

Class(es) Entered: *

Jr. Sportsman 1 Heavy
Jr. Sportsman 2 Heavy
Jr. Heavy (Raptor)
Jr. Heavy (Animal)
Jr. Sportsman Champ Heavy
Jr. Champ Heavy
Stock Lite
Stock Medium
Stock Heavy
Senior Stock (Animal)
Senior Champ (Raptor)
F200 Senior Champ
Sr. Champ Box Stock Animal
Animal Medium
Box Stock Animal
Sr. Champ Animal
Box Stock Animal Jr. Champ

Entry Fee Per Class: ($45.00 at gate)	$40.00
Fuel Per Class:	$5.00
Transponder Cost Per Class: ($3.00 if you own one)	$5.00
Pit Passes at Track
Amount Enclosed: *

This Form must be received one week prior to the scheduled event----Send Form To The Track!

For a reserved pit spot call track.

Tri State Kart Club Sugar Hill Speedway Poughkeepsie Speedway Richmond Raceway Londonderry Raceway
P.O. Box 247 197 Sugar Hill Road S. 345 Whittier Drive 343 Wiscasset Road 79 Ashland Street
Pomfret, CT. 06259 Weare, N.H. 03281 Mastic Beach, N.Y. 11951 Piston, ME 04345 Manchester, N.H. 03104
(860) 376-3148 (603) 529-2479 (631) 281-4396 (207) 582-0730 (603) 647-4053