Register Driver

This information will let us know more about you.
To complete the registration . Please have the following available:
Tax information (Social or Tax ID) & Sponsor information.

Driver Information


Agree to SMS
Get lineup text messages

Emergency Contact

Information is only shared with EMT staff.
  1. By filling this form, I understand that the information used or disclosed may be subject to re-disclosure by the person or class of person or facility receiving it, and would then no longer be protected by federal privacy regulations
  2. I may revoke this authorization by notifying the track/series in writing of my desire to revoke it. However, I understand that any action already taken in reliance on this authorization cannot be reversed, and my revocation will not affect those actions

Tax Information

Certification

Under penalties of perjury, I certify that:

  1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
  2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
  3. I am a U.S. citizen or other U.S. person (defined below); and
  4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.


I agree that my electronic signature is the legal equivalent of my handwritten signature.
SelectName Select all that applyQtyPrice
Late Model
1
$10.00
Track Membership
1
$15.00
Line Total$15.00
Processing Fee$2.30
Total$17.30

Media

Just some information for the announcer

Car Information

Track Membership

Consent to follow the rules.


I agree to all rules and terms of the La Crosse Speedway.
Processing Fee: $2.30
Total: $17.30