Kanabec County Fair 2010
Demo Derby
Entry Form
make checks payable to the “Kanabec County Fair”
READ all pages of The RULES carefully. The rules will be strictly enforced!!!
Pre registration: $35.00 Driver Only (July 21 or before) Late entry:$45 Driver Only (after July 21) Two Night Special – Pre registration ONLY - $70 Driver & Pit Person
Two Night Special – Non
refundable, if vehicle doesn’t return Saturday, you get 2 pit passes.
Pit Passes $20.00 each
Please indicate in which
night(s) & class you are entering and describe the vehicle:
May run a different class each
night with “Two night special”
Friday _____
Saturday ______
Compacts_____
½ Ton Truck _____
1980&Newer______
Mini Pick-Up
Truck______ Stock Heavy Trucks _____
(Friday)
Make________________ Model__________________ Car No.____________
(Saturday)
Make_________________ Model__________________ Car No.____________
Sponsor___________________________________________________________________
I
understand that the sponsors and administrators of the contest are not
responsible for any accident, injury, damage or mechanical breakage should
occur. In consideration of you accepting this entry, I hereby for myself,
my heirs, executors, and administrators, their agents, servants, and all other
persons connected with these competitions of and from any loss, damage, or
injury sustained by me or my equipment during this competition. Winners
may be required to complete a W9 to collect prizes.
I am 16 years of age or
older
Name________________________________________Date of birth________
Address________________________________________________________
City__________________State_________Zip____________County_________
Phone Number____________________________
Signature of competitor____________________________________________________
if under 18 years of
age, Parent or Guardian must sign the form and both signatures must be notarized
Signature of Parent or Guardian_____________________________________________
Subscribed and sworn to me before this_______day of ___________2010
Mail
completed entry to:
Notary public
John
Angstman