Crate Racin' USA Dirt Late Model Series

Chevrolet Performance World Championship

CLOSED ON: 09/04/2021 12:00 AM

CRUSA Dirt Late Models

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Competitor Information

Be sure to have correct COMPETITOR information in this section. Do not use a parent or team owner's information here. You MUST use the competitor's first and last name.

First Name

Last Name

Suffix (optional)

Street Address

Street Address Continued (optional)

City

Country

State

ZIP

Phone

Date of Birth

Competitor Misc

Additional information for the Competitor .

Nickname (optional)

Gender

Jacket Size

Owner Information

If payout is to be awarded to the team owner, you must complete this section.

Yes, I need to add my Team Owner's Information!

First Name

Last Name

Street Address

Street Address Continued (optional)

City

Country

State

ZIP

Phone

Payout Recipient

Class Information

Numbers the competitor would like to use when competing. Order by desire.

Requested Numbers

Years Raced (optional)

Transponder Number (optional)

Emergency Information

For emergency purposes, please list medical and contact information.

First Name

Last Name

Phone

Allergies/Notes (optional)

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CLOSED ON: 09/04/2021 12:00 AM

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