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TO BE FILLED OUT BY OWNERS OF RACING AIRPLANES 
(Entry will not be accepted unless complete information is given)

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[[column 1]]
Name of Owner
Make and name of Airplane
C. A. A. Number
Date of Manufacture
N. A. A. Racing Number
Make of Engines
Type of Engines
Bore
Cubic Inch Displacement
Total Engine Hours
Empty Weight
Span

[[column 2]]
Address
Type
Total Flying Hours
Date of last complete Overhaul
Color of Airplane
Number of Engines
Serial Numbers
Stroke
Supercharger Type
Hours since last overhaul
Wheel Size
Wing Area

[[full page width]]
Propeller (Metal, Wood or Plastic) (Fixed or Adjustable) .... Max R. P. M.
Manufacturer .... Model
Wing Loading Including Area displaced by Fuselage .... lbs.
Total Gasoline Capacity .... Oil
Is Craft Equipped with Lift Increasing Flaps? .... Seat Belt?
Shoulder Harness .... Parachute
Landing Gear (Retractable or Stationary)
Has Airplane been approved previously by a Race Technical Committee?
Where and When?
Has Airplane been modified in any way since such approval?
Give modification details 

Signature of Owner