ENTRY FORM

2010 DEMOLITION DERBY
JULY 3, 2010 - 1:30 P.M. MDT
Roughrider/DSU Outdoor Arena
Dickinson, ND

SPONSOR___________________________________________________________________

DRIVER ____________________________________________________________________

 UNDER 18 YRS OF AGE MUST HAVE A PARENT SIGNATURE & A VALID DRIVERS LICENSE

PARENT SIGNATURE ___________________________________________________________
(REQUIRED IF DRIVER IS UNDER 18 YEARS OF AGE)

ADDRESS___________________________________________________________________ 

TELEPHONE #_______________________________________________________________

TYPE OF VEHICLE ____________________________________________________________ 

MODEL OF VEHICLE __________________________________________________________ 

OTHER_____________________________________________________________________

FREE TO THE FIRST 15 FULL SIZE

CARS AND 3 HERBY CARS

ENTRY FEE - $50.00 ($20.00 for herby) if received on or before June 25.

LATE ENTRY FEE - $75.00 ($30.00 for herby) if received June 26 or after.

CARS LEFT WILL BE TOWED AT DRIVER'S EXPENSE!!

SEND APPLICATION TO:

          ROUGHRIDER COMMISSION
          P.O. BOX 895
          DICKINSON, ND  58602-0895

ENTRY FEE MUST ACCOMPANY THIS APPLICATION!

PRE-REGISTRATION ENTRY DEADLINE - JUNE 25, 2010