Running #________________
NAME:________________________________________________________________
Address:_______________________________________________________________
Phone: Day/Work #____________________ Evening/Home#__________________
Car:____________________ Make:________________ Model:______________
Driver's License #_______________________ State:____________
Mini Car:__________________ Stock______________ Outlaw:__________
In Case of Emergency, Accident, or Death, Contact:
Name:__________________________ Address:_________________________
Relationship:_____________________ Phone #__________________________
Pre-Registration is $30.00
Registration fee on day of the race is $35.00
If you want to register more than (1) car you can do it on this form
By signing this form I hae agreed that I will participate in the Demolition Derby at the Boyd County Fair on _______________________ of my own free will, and do hereby relieve the Boyd County Fairgrounds, Board County Fair Board, all promoter and track officials of any liablities from injury that may occur due to the possible dangers of this event. This includes but is not limited to all mental and physical injuries. I am over the age of 18 and responsible for myself.
Signature:___________________________________ Date:________________
Witness:_____________________________________ Date:________________
