Jump N Run Payment Form

2025 South Central Area Junk Car Jump N Run

Choose Racing Night Below
Choose Your Night!*
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Thursday Night Jump N Run$100.00
Includes Driver's Event Registration, Fair Entry and Pit Pass, as well as their Plus One's Fair Entry and Pit Pass.

Friday Night Jump N Run$100.00
Includes Driver's Event Registration, Fair Entry and Pit Pass, As well as their Plus One's Fair Entry and Pit Pass

Friday Night Powder Puff Jump N Run$100.00
Includes Driver's Event Registration, Fair Entry and Pit Pass, as well as their Plus One's Fair Entry and Pit Pass.

Total $0.00
$40 for 2 Race Night Gate Entries
$20 for 2 Pit Passes
$40 for Jump N Run Registration

= $100
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Date
Emergency Contact*

First NameLast Name
Emergency Phone Number*

Area CodePhone Number
Car Make*
Car Model*
Car Year*
Race Number*
Signature of driver OR Parent/Guardian Signature if driver is 16-17 years old.*

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2025 South Central Area Junk Car Jump N Run