DAWSON COUNTY RACEWAY LEXINGTON, NEBRASKA 2013 REGISTRATION FORM IMCA MODIFIED–IMCA STOCK CAR–IMCA HOBBY STOCK-IMCA SPORTMOD-IMCA SPORT COMPACT REGISTRATION FEE SEASON-PREPAID BEFORE APRIL 1,2013 $45 ________ REGISTRATION FEE SEASON-3 OR MORE NIGHTS AFTER APRIL 1,2013 $60 _______ REGISTRATION FEE 2 NIGHTS OR LESS $30 ________ ONE WAY RACECEIVER RADIO AND EAR BUDS $100 _______ RESERVED PARKING STALL ----OPTIONAL----------- $50 ________ TOTAL $____________________ CASH____________CHECK #___________________ DRIVER______________________________________________________________________ CLASS _________________________________________ CAR #________________________ ADDRESS______________________________________CITY___________________________ HOME PHONE (_____) ___________________STATE_______________ZIP________________ SOCIAL SECURITY #_____________________SPOUSE NAME___________________________ OWNERS NAME____________________________HOME PHONE (_____)__________________ ADDRESS______________________________________CITY___________________________ SOCIAL SECURITY#_______________________STATE______________ZIP_______________