Driver Name*

Address*


City*

State*

Zip*

Home Phone*

Work Phone

Fax

E-mail adresss*

Have you participated in an HMSA event within the past 12 months with the car(s) you are entering in the Coronado Speed Festival?
If yes what is the last event you entered with this car(s).
Yes No

List Car(s) Make, Model, Year and last event

Your 2010 Entry
Car (s)(Make, Model, Year) *

Car Color

Car Number (list first, second and third choices)

TIRE SIZE (List_exactly_as_shown_on_the_sidewall)
Front

Rear

Entrant/Driver acknowledges this car complies with all 2009 HMSA Rules and Regulations
Yes No

HMSA Member Number

$495 Per Car

Payment Information
(Online processing requires credit card. For payment by cash or check, please download race form and mail to the HMSA Office)
(check one)*:

MasterCard Visa Discover

Credit Card Number*:

Credit Card Expiration*:
Select Month: 01 02 03 04 05 06 07 08 09 10 11 12 Select Year: 08 09 10 11 12 13 14 15 16 17

Security Number(on back of card):


Name on Credit Card*:


Billing Address (if different than above) :
Address

City

State

Zip