Pre-Pay Form - High Roller Weekend
MUST be submitted by midnight 10 Sept for Discount

High Roller $5K to Win
Sept 23 & 24, 2023
Sat - Gates Open at 11 am, Blind Squirrel 12:30 pm & Time Run at 1 pm
Sun - Gates Open 9 am, Time Run 10:30 (New Entries ONLY) & Eliminations 11 am

Saturday Blind Squirrel
Sept 23
, 2023
1st -  Round Eliminations at 12:30 pm
$50 Entry & NO BUY BACKS

Off the Trailer - Rapid Fire Racing

Sunday Q16
Sept 24, 2022
Qualifying - (2) Saturday or 1 Sunday for those who don't entry Saturday
$120 Entry & NO BUY BACKS

Pre-Paying isn't required, but should reduce the line at the tech booth

Advantages to Pre-Paying

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


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

On-Site Saturday or Sunday Single Entry $100
On-Site Saturday or Sunday Double Entry $200


Single Entry (Sat & Sun) $185
Double Entry (Sat & Sun) $370

By pre-paying you will receive one free spectator

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

You may Pre-Pay at the track via cash or check by Sept 10, 2023
you can send a check postmarked 10 Sept or earlier to:
CCD, 4700 West State St, Charleston, IL.61920

Questions please contact us:
Email: / 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 Friday Gamblers    (Select one)
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 receipt

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

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

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