Wed, March 10, 2010
Please fill out all information and mail back, along with check for $60.00. All teams and money must be in by February 7th, 2010.
No team will be accepted without payment, no exceptions.
| Payable To: |
| Roy Wurgley |
| 110 Village Lane |
| Philadelphia, Pa. 19154 |
| Driver Selections |
| Group 1 |
| Group 2 |
| Group 3 |
| Group 4 |
| Group 5 |
| Group 6 |
| Team Informatiom |
| Name |
| Address |
| City, State, Zip |
| Phone |
| Your Team Name |