ENTRY FORM

2011 DEMOLITION DERBY
JULY 4, 2011 - 1:00 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

PRE-REGISTERED PRIOR TO JUNE 24

ENTRY FEE - $50.00 ($20.00 for herby) if received on or before June 24.

LATE ENTRY FEE - $75.00 ($30.00 for herby) if received June 25 or after.

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

Association rules state "all cars must be at the derby site at least ONE HOUR prior to the advertised start time of the derby!" In order to start the derby on time (1:00), we request you check-in no later than 1.5 hours prior to the advertised start time (11:30). Thank You!

SEND APPLICATION TO:

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

ENTRY FEE MUST ACCOMPANY THIS APPLICATION!

PRE-REGISTRATION ENTRY DEADLINE - JUNE 24, 2011