Date Submitted:__________________ Sign up #________________

Class:__________________________ Position #_______________

Alaska Motor Mushers Club

10^th Annual Intimidator 150 Larry Heal Memorial

Cross Country Snowmachine Race

Entry Form

ALL DRIVERS MUST COMPLETE (PLEASE PRINT) THE FOLLOWING

Name________________________________________ SS#________________________

Address______________________________________ Home Phone_________________

City_____________ State__________ Zip__________ Work Phone_________________

DOB__________ Birth State/Country_________ Fax___________ Email______________

Machine Make_________________

Race Class Entered:

A. 0-600cc Pro _____ Entry Fee $200 + membership

B. 0-600cc Semi-Pro Womens _____ Entry Fee $100 + membership

C. 0-600cc Semi Pro _____ Entry Fee $100 + membership

D. 0-600cc Semi Pro Veteran _____ Entry Fee $100 + membership

E. 0-600 Sport Trophy _____ Entry Fee $50 + Membership

Insurance fee $40.00 per racer.

You must be an AMMC member to race.

FAX ENTRY FORMS MUST BE PAID WITH CREDIT CARD 5% HANDLING CHARGE

FAX # (907) 495-5010

CC #___________________________________________ EXP _____/______

Entry Fee $________ Membership Fee $________ Insurance Fee $ 40.00

Total Paid $_____________

Sponsors__________________________________________________________________________________________________________________________________________________________________________________________________________________________________