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2nd Annual Jerry Burhop Memorial Late Model 150 Entry Form
Please fill out this Entry Form and click submit at the bottom. You can email
r.snyder632013@gmail.com
if you have any questions.
Entry fee is $100 for Car & Driver from now until 6/3/22 at 11:59pm PT. The Entry fee is $150 on 6/4/22. Crew members are $35 each. You can mail a check to:
SMH Enterprises, LLC
22537 Radnor Lane
Moreno Valley, CA. 92557
Please put your Car Number & Driver Name on the Memo on the Check. This fee includes transponder rental for the weekend and entry into the race. Entry fee is non-refundable. Along with your entry you will need to note how many tires you would like to purchase for this event so we can be sure to have enough tires available at the track.
*
Indicates required field
Driver Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Alt. Phone Number
*
Email
*
Engine Type
*
602
Open Engine
Name of Person Responsible for 1099
*
First
Last
Address for 1099 Person
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number for 1099 Person
*
Tires Requested
*
Submit
Home
Buy Tickets
Events
2023 Track Schedule
Hotpit Autofest
Demo Derby
5th Gear BBQ Jr Fan Club
MEDIA
News
Photos
Videos
Drivers
Race Results
2023 Points
Track Rules
2023 Entry Form
2022 Points
Shop
Connect
Instagram
Twitter
TicTok
YouTube
Facebook
About
About the Track
Contact Us
Meet the Team
Media Center
National Anthem