Stock Car Registration Form - Western Speedway

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Western Speedway
Western Promotions Ltd.
2207 Millstream Road
Victoria, B.C. V9B 0J7
Phone at track: 250-474-2151
Stock Car Registration Form
Last year’s Car Numbers will be held until March 15th. All numbers after March 16th are open to first come, first
serve basis.
Registration Fee $100 (Payment must accompany this form to register)
CAR #______
NAME: ___________________________________________________________________ AGE___________
ADDRESS______________________________________________________ CITY______________________
POSTAL CODE_______________________ EMAIL________________________________________________
PHONE: ( HOME)__________________________________ (CELL)___________________________________
CAR/MAKE/YEAR___________________________________________________________________________
Do not add visa number if you are going to email this form to us. Please phone us your Visa number
METHOD OF PAYMENT: VISA#_____________________________________________ EXP DATE________
CHECK
CASH
SPONSORS________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
CAREER HIGHLIGHTS:______________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Remit Registration Form and Payment to: Western Promotions Ltd.
2207 Millstream Road Victoria, B.C. V9B 0J7

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