SUPERPRO SERIES 2010 DRIVER REGISTRATION

DRIVER NAME:_________________________________________________________________________________________________________________

ADDRESS:____________________________________________________________________________________________________________________

CITY:____________________________________________________________ STATE:______________ ZIP:____________________________________

HOME PHONE: ________________________________________________________________________________________________________________

E MAIL ADDRESS: _____________________________________________________________________________________________________________

SOCIAL SECURITY NUMBER: ___________________________________________________________________________________________________

SUPERPRO CAR NUMBER: ____________ CHASSIS TYPE: __________________________________________________________________________

BODY STYLE & YEAR: _________________________________________________________________________________________________________

SPONSORS:__________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________________

EMERGENCY CONTACT NAME & NUMBER:_________________________________________________________________________________________

CAR OWNER NAME: ____________________________________________________________________________________________________________

ADDRESS: _______________________________________________________ CITY: ______________________________ STATE:___________________

ZIP: _____________ PHONE: _______________________________________ E MAIL: ________________________________________________________

NAME AND TAX ID OR SS NUMBER FOR 1099:_______________________________________________________________________________________

We understand the severity and inherent danger in stock car racing. Death, injury, and temporary or permanent disablement can occur from competiting in any race event including SUPERPRO racing events. Together and individually and for our and on behalf of our estates and assigns, we hear by hold harmless SUPERPRO, LLC, its officials and employees of any injury, illness, death, or disablement that may occur while participating in any event held by or in conjunction with SUPERPRO, LLC. 2010 SUPERPRO driver registration is $150.00 for the entire season . EARLY BIRD REGISTRATION IS $125.00 IF PAID BY FEB. 1, 2010. A ONE RACE REGISTRATION FEE IS AVAILABLE FOR $50.00 PER RACE.

Return completed form to: SUPERPRO, LLC PO BOX 6390 JACKSON, MI 49204