Mail Checks Payable
To:   F.M.S.A.
1450 E. Taylor Rd.
Deland, FL 32724
www.flminisprints.com
jesseteed@flminisprints.com
PLEASE PRE-ENTER IT HELPS F.M.S.A., and YOU WITH Registration Before the Races!
Reasons for Pre-Entry: Pre-Entry Form Due by Feb. 7th. 2013 - (1st. come,1st. serve on Guaranteed
Available Car #’s ), Track Pre-Entry Totals, Announcer’s List,
Programs Listing, Mail Listings, Paid Officials, etc.
All Entry Fees Do Not Include Pit Gate Fee or Usage of
Transponders! "See Brochure for Transponder Information"
Race Receivers are Mandatory on All F.M.S.A. Event
$30 Ea. Night Entry Fee with Completed Entry Form-
Pre-Entry Pays for 1st.Night of Competition,  can
also pay for all nights of Competition in advance.
Example:
1-Night-$30 + Pit Gate Fee,
3-Nights-$ 90 + Pit Gate Fee
$35.00 Per Night if Pre-Entry Not Received before Feb. 7th. 2013
1st. Available Car #: _______ 2nd. Available Car #:_____________
Driver:________________________________Address:_______________________________________________________
City, State, Zip Code: _______________________________________________
Engine Mfg. _____________ Circle One: 600cc  636cc 750cc   
Chassis Mfg. __________________
Sponsors: _______________________________________________________________________
Achievements:____________________________________________________________________
S.S.N.: _______-_____-_______ PH.#:(_______) _______-_________
EMAIL: ____________________@________________
In Case of Emergency
Contact: __________________________________________________
Blood Type: _________________________ Allergies: _____________________
Injury Release
I agree that when I participate in any Florida Mini Sprint Association LLC event or function, I do so at my own risk and
that Florida Mini Sprint Association LLC, officers, members, crew, participants or tracks are not responsible for my
safety of bodily injury or any damage to property belonging  to myself.                                                                          
                                                
Signed: ___________________________________ Date: ___-___- 20___
-----------------------------------------------------For F.M.S.A. Office Use Only ----------------------------------------------------------------------------------------------------------------------------------------------------------------
Date Received Form: ________      Approved Car #: __________  

Payment:_____________   

Post-Paid Entry-$35.00- Circle Ea.Date:  
                   2/21 2/22 2/23
-----------------------------------------------------For F.M.S.A. Tech Inspection Use Only ------------------------------------------------------------------------------------
Circle One: 600cc   636cc   750cc - Passed     Failed
Pre-Inspection- Circle Ea.Date:   
Top (6) Finishing Positions-
Passed Post-Inspection-  
FMSA Tech Initials:______


2/21- Heat #____ Pos.#____ Feature A/B Pos.#_____
2/22- Heat #____ Pos.#____ Feature A/B Pos.#_____
2/23- Heat #____ Pos.#____ Feature A/B Pos.#_____
Bore:_________
Stroke:________
cc's:_________
                  21st. Annual F.M.S.A.
                              Winternationals
                                       East Bay Raceway Park
                                        Feb. 21st. 22nd. 23rd.
                                                 Tampa,FL                        
                                                                 Racing with King of 360 Sprints
Driver Pre Entry Form
Car #: ____________

__________  cc's

Post-Paid Entry-$30.00- Circle Ea.Date:
                    2/21 2/22 2/23