2008 NeSmith LATE MODEL SERIES DRIVER/CAR OWNER INFORMATION SHEET AND MEMBERSHIP FORM Car Info Car Number Car Colors Primary Sponsor Secondary Sponsors: Chassis Engine Model choose oneCrate model 602Crate model 604 Home Track: Crew Info Crew Chief Crew Members: 1099 Info Recipient choose oneCar DriverCar Owner ID # (Tax ID or SSN of recipient) Driver Info Full Name Driver's ID # (driver's license or SSN) Address 1 Address 2: (apartment #, etc.) City State choose oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Daytime Phone: Evening Phone: Cell Phone: Fax Number: Email Address: Website Address: Experience (Years Racing, Types of Cars Raced, Championships, Etc.) Car Owner Info - leave this section blank if driver is also the owner Full Name Address 1 Address 2: City State choose oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Daytime Phone: Evening Phone: Cell Phone: Fax Number: Email Address: MEMBERSHIP FEE Only NeSmith Dirt Late Model Series members will be eligible for points and contingency awards for both the NeSmith Dirt Late Model Series National Tour, and the NeSmith Weekly Racing Series. The one-time Membership Fee of $100.00 will enable a competitor to be eligible for points and contingency awards at any NeSmith Dirt Late Model Series National event, and/or at any NeSmith Weekly Racing Series track. You can send a check or money order payable to Crate Racin' USA. Crate Racin' USA P.O. Box 1346 Cartersville, GA 30120