Track: Montgomery Motor Speedway Race Date: Sept 10 &11,2016
Location: Montgomery, AL Division: Southern Super Series Race Start: See Attached Schedule Distance: 200 Laps Fuel: Sunoco 110 from (15 gal Min. purchase) Promoter: Stan Narrison & SSS Tires: Hoosier F-45 (Impounded/8 TIRE MAX FOR RACE.)
PURSE $7000 TO Win $600 to Start FAST QUALIFIER AWARD $500
DRIVER____________________________________________________________________ CAR #_______________
SOCIAL SECURITY #_______-______-_______ E-MAIL__________________________PH (____)_______________DOB______
PERSON RECEIVING PRIZE MONEY____________________________________ADDRESS_______________________________________
SS # or FED I.D. __________________________________________________________________________________
Entry Fee: $150.00 Late Entry Fee: $175.00 Please Make all checks payable to: Southern Super Series, LLC Please send all checks to: Southern Super Series 7451 Pine Forest Rd. Pensacola,FL 325 Ph (850)-944-8400 Fax (850)-944-8409 ENTRY AND ADVERTISING RELEASE: The undersigned understands and agrees that their name and likeness may be used by Southern Super Series (SSS) and authorized agents in any way, medium, or material to promote, advertise, record, or report this event before, during, and after the event, and do hereby relinquish all rights hereto for these purposes. The undersigned understands and agrees that all decisions made by SSS Officials will be final and without recourse. In the event that this application is terminated, it shall be without restitution of any part of the fee paid with this entry and further, waives any and all rights or claims to any bonus money due to or resulting from racing efforts with SSS prior to SSS termination. The undersigned further waives any and all rights for themselves, their agents and assigns, to institute any action, suits or proceedings, whether at law, or any other action against SSS and its officers, directors, agents and employees for any and all, manner or actions, cause and causes of actions, suits, damages, and claims that the undersigned and their heirs, successors, assignees may have now, or at any time in the future may have, arising in any manner from SSS promoted events, excepting SSS obligation to pay purses, bonuses, and awards as set forth in the Official entry form for SSS promoted events. The undersigned understands and agrees that this constitutes a wavier of any and all claims for personal injury, breach of contract, and any other loss of damage except as expressly provided herein.