Portland International Raceway Dragstrip PAID:__________________

1940 North Victory Boulevard cash/check

Portland, Oregon 97217

Office: (503) 626-0579 Fax: (503) 626-3339 SHIRT SIZE:_____________

www.portlandraceway.com

 

P.I.R. Dragstrip TEAM SIGN UP – 2006

IF YOUR ADDRESS CHANGES DURING THE YEAR, PLEASE NOTIFY THE OFFICE. (PLEASE PRINT)

NAME: ______________________________________ DATE:_________

ADDRESS: _____________________________________

CITY _________________________________STATE_______ZIP_____________

SSN. #__________________ FAX #: (_____)_________________

EMAIL:_________________________________

EMERGENCY CONTACT #:(_____)_________________

HOME PHONE #: Area code (______)________________

IF HIGH SCHOOL NEED AGE:____________

WORK PHONE #: _________________ (OPTIONAL) CELL PHONE #: _____________

CLASS: ___________________________________ CAR #: ______________________

(SUPER PRO-PRO-SPORTSMAN-*MX-HIGH SCHOOL-Jr.DRAGSTER) (IF YOU HAVE AN NHRA #, PLEASE USE)

YEAR/MAKE/MODEL/COLOR OF CAR OR MX:

________________________________________________________________________

(NEED THIS FOR PICTURES)

 

*NOTE: IF YOU ARE A MOTORCYCLE, YOU MUST COLLECT POINTS WITH MX AND NOT WITH CARS.

IN 2006 ALL MOTORCYCLES WILL RUN AGAINST MOTORCYCLES ONLY.

 

NHRA MEMBERSHIP #: ____________________EXPIRATION DATE:____________

NHRA LICENSE (CAR) #:___________________EXPIRATION DATE:____________

HIGH SCHOOL REPRESENTED (IF APPLICABLE) ____________________________

FAX TO: 503-626-3339 ¤ MAIL TO: 35 SW 131st Ave. Beaverton, Or. 97005 ¤ E-Mail TO: pmaciaspir@yahoo.com