Winchester Pre-Registration

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2021 WINCHESTER "RUN FOR THE GUN" - EVENT ENTRY Registration

2021 WINCHESTER ENTRY FORM (Entry form does not guarantee a starting position)

$150.00 ENTRY FEE AFTER October 4th
IF YOU DO NOT REGISTER BY deadline, YOU WILL NOT START ANY BETTER THAN 10TH IN THE FEATURE

* Indicates required field

DRIVER Name *

First

Last

Phone Number *

Email *

OWNER Name (if NOT Driver) *

First

Last

EMERGENCY CONTACT Name *

First

Last

Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

CAR # *

MAKE OF CHASSIS *

CREW CHIEF *

First

Last

MAIN SPONSORS *

WAIVER: I understand that racing is a dangerous activity and could result in Bodily injury and or death. I assume all risk associated with Being at a race venue. I, for myself and for anyone entitled to act on my Behalf, waive and release Midwest Modifieds Tour and the Race Track hosting the event along with their owners, promoters, officials, sponsors and their representatives for all claims or liabilities of any kind arising out of my participations in this event. *

<-- I UNDERSTAND

By submitting this I hereBy agree to aBide By all MMT and track rules and regulations. I hereby give MMT the right to use pictures or videos of myself, or my race car for promotional purposes. I agree to have all tax forms on file with MMT. If my car is found to be in rule infraction, I will return all prize money within 7 days. *

<-- I AGREE

Submit

$150 ENTRY fee required after submitting above

2021 WINCHESTER "RUN FOR THE GUN" - EVENT ENTRY Registration

2024 MIDWEST MODIFIEDS TOUR (- all rights reserved)