Pre-Pay Form - Double Nickel
MUST be submitted by midnight 22 May for Discount

High Roller $5K to Win

May 29 & 30, 2021
Gates Open at 11 am - Time Runs at 1 pm


Pre-Paying isn't required, but should reduce the line at the tech booth thus helping us with Social Distancing.

Advantages to Pre-Paying



1) allows to print a submission receipt and shown at the front gate to speed up that process. 
2) Separate Line at the Tech Booth to Sign-In & get wrist-bands
3) Self Tech - pre-print Tech Card & fill out before you come to reduce wait time & line

 

NHRA & CCD Double Nickel Tech Card
(CLICK HERE For Printable Tech Card)
This form can be filled out with your computer & then printed or hand-written & printed


For more info click on the flyer:

Saturday or Sunday Single Entry $100
Saturday or Sunday Double Entry $200

WEEKEND PRE-PAY DISCOUNT (Pre-Pay MUST BE MADE BY MIDNIGHT 22 MAY)
Single Entry (Sat & Sun) $185
Double Entry (Sat & Sun) $360

By pre-paying you will receive one free spectator

There is 4% Square Service Fee added to your Credit Card purchase

 4700 West State St, Charleston, IL.61920

Questions please contact us:
Email: colescountydragway@gmail.com / Phone (217) 345-7777


Your Information...

Your Name:** (Required)  
Your Credit Card # ** (Required)  
Expiration Date ** (Required)    (MMYY)
Security Code ** (Required)  
Zip Code ** (Required)  
Amount of High Roller Entries ** (Required)    (Select one)
Blind Squirrel Entry    (Select one)
Quick 16 Entry    (Select one)
   
   
Amount of Crew ** (Required)    (Select one)
Phone Number ** (Required)    (No Dashes)
Your Email:** (Required)  

 

You will receive a phone call or email with confirmation reciept

Please Click the "Submit" button only ONCE...
Then wait for a Form Confirmation Page to indicate the information has been sent.
You may print the "Confirmation Page" by pressing "Control P" at the same time to bring up a print window
(Please WAIT and be patient, it sometimes takes 15 to 30 seconds)




Track and Mailing Address: 4700 West State St, Charleston, IL 61920
Track Phone: 217-345-7777 - Rods Phone: 217-512-0673
Email: colescountydragway@gmail.com

2010 - 2018 Coles County Dragway USA, LLC - All rights reserved. Unauthorized use of material is prohibited.
 

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