2nd  ANNUAL G-MAN DIAMOND STATE "50" SHOOT – OUT

US.13 Kart Club
**October 10, 2009**
Rain Date Oct 11th

Pre - entry form

**No Refunds**

Mail check to - US.13 KART CLUB

                          P.O. Box 954

                          Georgetown, DE. 19947

Adult Name _________________________________   Kart #_________

Child Name _________________________________   Kart # ________  Age ______

Phone #       ______________________ **Please Print all Your info**

Pay by Oct. 5th - Save $10.00

Reg. Price $50.00     All fees do not include wrist band

JR I Hvy   265 lbs  ________ 

JR II Hvy  290 lbs ________    

JR III Hvy 320 lbs ________

Reg. Price $50.00    All fees do not include wrist band

Flathead Hvy 375 lbs ______

Animal Lite    325 lbs ______

Animal Med.  350 lbs ______

Reg. Price $60.00    All fees do not include wrist band

Animal Hvy   375 lbs ______

Total - $________

If you have any questions call Phyllis Hayes, the Treasurer of the U S 13 Kart Club Track

Phone 302-856-7835