We will never share your information. We value your privacy!

Don't want to fill out online? Here's a PDF form you can print and bring with you to the track. CLICK HERE!

Name *
Please enter your first and last name
Do you have a nick name you'd like the announcer to know?
Phone number *
Phone number
Please enter your phone number
Address *
Please enter your mailing address
*If you race in more than one division, please fill the form out for each division
Emergency Contact *
Emergency Contact
Please enter the name of your emergency contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Please enter your emergency contact's phone number
Please enter the first and last names of all crew members and anyone that will be in the pits with you *If under 18, please list age
Please list all sponsors for our announcer
Anything you think our announcer should know?

*** Disclaimer - If you are in a paying division, you are REQUIRED to have a W-9 on file with our Pit Box. Be prepared to provide your social security number upon your first visit to Havasu 95 Speedway. ***