LongIslandJam.com -- News Room

2005 LONGISLANDJAM.COM/1-877-CAN RACE FEEL THE THRILL DAY
Sunday, June 26, 2005

Personal Information:
Full Name:
Date of Birth (MM/DD/YYYY):
Have Valid Driver License?	Yes No
Address:
City:
State:
ZIP Code:
Phone Number (include area code):
Preferences:
Type of Car:	Modified Late Model Pro Stock NASCAR Cup
## of Laps: Note: Must be 18 and possess a valid Driver's License to race 24 or 50 lap programs).	20 laps - $174.99 (reg. $249.99) 30 laps - $249.99 (reg. $349.99) 50 laps - $449.99 (reg. $599.99) 70 laps - $599.99 (reg. $799.99) 120 laps - $849.99 (reg. $1,149.99) Ride With a Pro - $49.99 (reg. $59.99)
Want In Car Video? 20 laps: $29.99 30 laps: $39.99 50 laps: $49.99 70 laps: $69.99 120 laps: $89.99 Ride with Pro: $19.99	Yes No
Want Insurance? $50 with a $1,000 deductible	Yes No
Any other questions or comments?

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