SPONSOR INFORMATION

 Please print your information below:

 Name: _________________________

Business Name: __________________

Address:________________________

City, State, Zip: ___________________

Phone: _________________________

Sponsor Amount (please check box)

[ ] $500.00 (start/finish line brick)

[ ] $250.00 (pit area)

[ ] $ 100.00 (other locations)

Specify what you want on the brick

(maximum 2 lines, 15 characters/line, spaces and other punctuation are considered characters)

Line 1: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Line 2: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Send a check or money order, along

with this form, to:

WQMA Track Fund

9724 32^nd Street SE

Everett , WA   98205