ENTRY AND ADVERTISING RELEASE: In consideration of the awards for events, the acceptance of this entry and the sanctioning of this event (s) by the Promoters, (meaning Chowchilla Speedway or NCDCA) the car owner and drivers, individually and jointly agree that the promoters and it’s assigns may use their names and pictures of the car described herein, or any of them, in any way medium, or material for promoting, advertising, recording or reporting this event or other events before during and after such event and do hereby relinquish all right hereto for these purposes. The promoters reserve the right to refuse entry to any party.

CHOWCHILLA SPEEDWAY AND NOR-CAL DWARF CAR ASSOCIATION, INC.

Applicants Signature___________________________Date_____________

Drivers Name:___________________________________________________
Owners Name if different:________________________________________

Social Security Number: Driver or owner- Please specify:_______________________________

Phone:__________________________ Organization:____________ Pro____Senior ____

Sportsman___(Sportsman Entry $100.00 for drivers event pit pass)(late entry sportsman: $125.00

Address:________________________City________________State__________ Zip______________

Car # (include association letter)___________________

Pre-entry Fee $175.00_________(includes drivers event pit pass and T-Shirt)

After 9-15-10 or non-member $200.00_________

Please fill out the form above and return to:

NCDCA

3165 N. Holly drive

Tracy, Ca. 95376

209-832-8508/209-836-4722

Host Hotel:Holiday Inn Express Chowchilla

ask for Chowchilla Speedway Group Rate $89.99 (559) 665-3300

Make reservations by NOW! Deadline is 9-15-10

Other Motels: