Northwest Pro4 Alliance
2017 Participant Registration
Early Bird Registration
November 1st, 2016– January 15th, 2017:
$100.00
Annual Registration Fee (after January 15th): $125.00

We need your information to set up pre-season promotions and update your driver pages on the website. If you
get your registration form returned before January 15th you will receive the Early Bird discount. For registrations
sent in after 1-15-17 please send $125.00.

No duplicate numbers in 2017, the tracks that score our events by hand asked us to fix this. Any cars showing up
with any registered cars number will have to change it. Questions, please contact Mike Hunter(509)-750-3101

By registering with the Northwest Pro4 Alliance, you agree to fallow the rules set in the rule book and to allow the
series to use your likeness, photos and video tape of you and your race car to promote the series and all race
events.

Fees collected will be used to promote the Northwest Pro4 Alliance Challenge Series in our efforts to obtain
sponsorship, race dates, cover expenses and to make your racing experience a fun and exciting one. Your
support is greatly appreciated.

Send this completed form and your check or money order made payable to:
Northwest Pro4 Alliance at 1059 Parker Ct
Prosser WA 99350
CAR NUMBER
ALTERNATE NUMBER
DRIVER’S NAME
MAILING ADDRESS
CITY
STATE
ZIP
PHONE NUMBER
E-MAIL ADDRESS
YEARS RACING
ROOKIE OF THE YEAR CONTENDERS. Less than 5 starts in a Pro4
OWNERS NAME
MAILING ADDRESS
CITY
STATE
ZIP
PHONE NUMBER
E-MAIL ADDRESS
WHO RECIVES PAYOFF
SSN#
EMERGENCY CONTACT NAME
RELATIONSHIP
PHONE NUMBER
BODY STYLE
12/2007
MAKE & SIZE OF ENGINE
SPONSORS
1.
2.
3.
4.
5.
6.
7.
8.
CREW CHIEF
Crew below
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
I hereby acknowledge the following;
I will fallow the rules and procedures set in the rule book
I am aware of the dangers and risks involved with this sport;
I willingly, knowingly and voluntarily enter these events and assume all associated risks.
The undersigned acknowledges that an IRS 1099 Form will be filed on any purses totaling over $600.00 and sent to
them.
X________________________________________
For office use only:
Date Rec’d ____________
Reg,# (
)
12/2007