Reads Racing Unlimited, Inc.
13253 East State Road 114
Akron, Indiana 46910
1-574-893-1649
 
Demolition Derby Entry Form
 
Allen County War Memorial Coliseum
Fort Wayne, Indiana
Friday January 23, 2009 & Saturday January 24, 2009
 
Driver Name: ___________________________________________
 
Car Number: ___________
 
Date of Birth: ___________
 
Address: _________________________________________________
 
City: ___________________________________
 
State: ___________________________________
 
Zip Code: ___________________________________
 
Please Circle One Day per Form:
 Friday Saturday
*Stock class runs Friday night only*    
 
THIS IS A RELEASE AND INDEMNITY AGREEMENT - READ IT BEFORE SIGNING
I hereby give up all my rights to sue or make any claim for damages due to negligence or any other reason whatsoever against Reads Racing Unl. Inc., the promoters, sponsors, property owners, and all other persons, participants or organizations conducting or connected with this event for injury to property or person I may suffer, including crippling injury or death, while participating in the event and while upon event premises. I know the risks of danger to myself and my property while preparing for and participating in the event and while upon the event premises and relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all costs to those persons or organizations connected with this event for damages incurred as a result of my negligence.
 
This is a release:______________________________________________________
Signature of participant  
 
 
Participants in Derby classes must be at least 18 years of age
Participants in UTV Side-by-Side Racing must be at least 16 years of age and hold a Drivers License.
 
Please circle one:
     
Outlaw Class Stock Class UTV Side x Side Racing
 
Outlaw Derby Class $50.00
Stock Derby Class $25.00
UTV Side-by-Side Racing $25.00
 
The following questions will help our announcer. Please take a moment to fill in the following:
 
Sponsors:
 

__________________________________________________________________________________
 
__________________________________________________________________________________
 
How many years have you been entering Derby's? ______________
 
Derbies you have entered, won, or any derby you are proud of participating in:
 
__________________________________________________________________________________
 
__________________________________________________________________________________
 
 
Entries are limited to the first 20 entries per night. Please call us at 574-893-1649 OR 574-551-8102 to let us know you are entering!
 
Entry Fee $50.00 per night
 
Mail entries to:
Reads Racing Unlimited, Inc.
13253 East State Road 114
Akron, IN 46910
Attention: Pre-Entry Department
 
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Reads Racing Unlimited, Inc.
13253 East State Road 114
Akron, Indiana 46910
1-574-893-1649