To use this order form, just print out this page, fill in the appropriate information and mail with your payment of $35.00 plus $1.00 shipping if outside of the continental USA or Canada.to:

Granite State Race Services, P.O. Box 990, Newport, NH 03773-0990.

Check enclosed: $ _________ (Please make checks payable to Granite State Race Services).

Last Name _____________________________________________|

First Name _____________________________________________|

Mailing Address _________________________________________|

City __________________________________________________|

State/Province __________________________________________|

Zip/Postal Code _________________________________________|

Country _______________________________________________|

E-mail Address _________________________________________|

Home Telephone ________________________|

Age __________|

Sex __________|

Date of Birth: Month ______| Day ______| Year _________|