Drivers Registration Form
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Southern States Midget Association
2009 Driver’s Registration Form
Drivers Name: ________________________________________________________________________
Address: ______________________________________________________________________________
City, State, Zip Code: ___________________________________________________________________
Home Phone: _____________________Cell : ______________________ Work :___________________
Emergency Contact:__________________________________________ Phone : ___________________
Email Address: ________________________________________________________________________
Blood Type: ____________ Allergies: _____________________________________________________
Medications: __________________________________________________________________________
Marital Status: _______________________ Children: ________________________________________
Occupation: ___________________________________________________________________________
Hobbies: ______________________________________________________________________________
Racing Experience: _____________________________________________________________________
______________________________________________________________________________________
Additional Information: _________________________________________________________________
______________________________________________________________________________________
Please complete and deliver this form along with a check or money order made payable to SSMA for $30.00 to Matt DeWitt prior to competition .NO PAYOUT nor POINTS WILL BE AWARDED UNLESS THIS FORM AND FEE ARE RECEIVED. THIS WILL BE ENFORCED, NO EXCEPTIONS !!!!!!!!!
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