2010 Five Mile Point Speedway Car Number Registration Request and

Media Sheet

Driver Name:________________________________________________________

Nickname: _________________________ No. of years racing: ________________

Hometown:__________________________________________________________

Division: __________________________________________________________

*Car Number Requested: 1^st choice _____________

2^nd choice_____________

3^rd choice _____________

Figure 8 Teams only: Are you requesting a Nextel Cup paint scheme? (yes)__ (no)___

E- Mail Address:_______________________________________________________

Driver Website: ________________________________________________________

Phone Numbers: (eve.) ______________________ (cell)______________________

Driver Information: (not required, for announcer use only)

Age:__________ Family:_______________________________________________

Driver Sponsors: ______________________________________________________

______________________________________________________________________

Driver Achievements:_____________________________________________________

Would you like you website linked to the fmp and/or rocdirt website?_________________________

(we ask that you include fmp or rocdirt related information on your site in return)

Please return this form to: Five Mile Point Speedway- PO Box 54 – Kirkwood, NY 13795

Or fax the form to 607-775-3417. If emailing - copy and paste this document in an email addressed to fivemilepoint1@aol.com. Attachments will not be opened.

Please forward any driver cards, team photos, press kits or any other information that can help us to better promote your team efforts.

*note – car numbers are awarded based on previous membership, participation and first 2009 paid membership applications.