2023 Hoosier Hundred

Entry Name*

Ex: Wyandotte Tool Special

Car Number*

Priority Based on Entry Date & Final 2022 USAC Silver Crown Series Owner Points Standings

Pit Stall Selection*

Priority Based on Entry Date (Earlier Entry = Priority)

Drivers Name*

First NameLast Name

Drivers Email*

example@example.com

Drivers Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Person Receiving Prize Money (Must Match W-9)*

Car Owner/Person Receiving Prize Money (If not driver)

First NameLast Name

SS or Tax ID#

W-9 File Upload

https://www.irs.gov/pub/irs-pdf/fw9.pdf

Phone Number

Please enter a valid phone number.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Team Point of Contact (If not Driver or Owner)*

First NameLast Name

Primary Phone Number*

Please enter a valid phone number.

Primary Email*

example@example.com

Sponsors (Please include at least two)*

Chassis Manufacturer

Engine Manufacturer

Comments

Entry Information

With submission of entry, Driver and Car Owner agree they have read, and will abide by all the USAC Silver Crown Series/Hoosier Hundred rules and decisions, as well as the stipulations in the entry blank. Entry may be rejected if all required information is not provided. Minors under the age of 18 must have a minor's release signed at the track in view of the pit registrar. The release must be signed by the custodial parent or legal guardian. Proof of age and parental custody are required. Contact appropriate series for rules and any questions.&#13;&#10;Entry fee will be deducted from the entrant's purse payout post-even unless otherwise arranged with the promoter and does not guarantee a starting position. Submit only if you intend to race.&#13;&#10;GOOD FAITH TO THE PUBLIC PLEDGE - In submitting this entry blank, both driver and car owner recognize their obligation to the public and race promoter posting the prize money and conducting this event. Therefore, we agree to compete in the event if humanly possible unless this event is postponed, cancelled or if the car fails to qualify for the starting field.

Acknowledgement

I acknowledge that I have read and understand the current form. By submitting I agree to comply with all rules and regulations of this event.

2023 Entrant Registration