Team Information

Team Name
Team Manager (person to contact for questions)
Drivers Name (maximum 4 drivers for NCMP 200)
Co Driver's Name
Co Driver's Name
Co Driver's Name
Address
City
State / Zip	/
Daytime Phone of Team Manager
E-mail of Team Manager (We are having trouble with Yahoo accounts bouncing back, please leave the ".com" off your email if you are having trouble with your entry bouncing back)
Transponder # (if you own one)
Credit Card Number (VISA, MC, DISCOVER) NO AMEX!
Expiration Number
CCV Three Digit Security Code on Back of Card (VISA, MASTERCARD or DISCOVER)
VERY IMPORTANT! All numbers must be 1 or 2 or 3 digits - No letters allowed! Please give your desired kart number	- 1st choice - 2nd choice

Event Information (check all applicable boxes)

Race Date	October 4-6 (Friday-Sunday)
Class Entry (check box) - Tire sets includes IN sales tax (DOES NOT INCLUDE PIT PASS!)
NCMP 200 $740.75 Select NCMP 200 Entry Includes 1 set of MG tires
Transponder Rental ($10.70 per team)	Please make selection No Transponder Needed 1 Transponder Rental - $16.05
Two Day Pitpass Driver and/or Crew You can also wait to buy your pit passes at NCMP	Please make selection None, Will Purchase at NCMP 1 additional pass - $18 2 additional passes - $36 3 additional passes - $54 4 additional passes - $72