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
SelectName Select all that applyQtyPrice
Line Total$0.00
Processing Fee$0.00
Total$0.00

Media

Just some information for the announcer

Car Information

Consent to follow the rules.


I agree to all rules and terms of the Jefferson Speedway.
Processing Fee: $0.00
Total: $0.00
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