Jerry Burhop Memorial 150 Entry Form

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