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Drag Race School Date _______________ Name _____________________________________ Address ___________________________________ __________________________________________ Home phone number _______________________ Work phone number _______________________ Mobile phone number ______________________ Fax number _______________________ Credit card number ______-______-_______-________ Expiry ___-____ Name on credit card ______________________________ There is a printed number on the back of your credit card on the signature line. Would you
give us the last Birth date_________________
Height _________
Weight _______
When did you see
your first How many times have you been to a drag race ? _______ Have you ever "lit the top bulb" on the tree ? __________ When ? _______________________________ What type of car ? _______________________ How quick did you run ? ___________________ Have you ever crewed on a drag race car ? _______ What type of race car was it ? ___________
If you get your
license would you like to compete
If you won the
lottery what type Would you make a career of driving a race car ? __________
Do you want to have
your ANDRA license
What type of drag
race car are you interested in? ________
Have you applied
for your ANDRA
Have you received
your
Please add any
information that can assist us in your
Name (print)
______________________________
2. Please fill out the form completely and return
3. If you don't have a credit card please
Drag Race School
Phone: 0411-699-535 If you
have any questions about our Drag Race School please ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ ¡@
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