Heritage Trails District Derby Day Individual and Pack Registration Form Saturday, March 30, 2019, 10am to 4 pm St. Paul’s United Methodist Church 45 First Avenue, Red Lion, Pennsylvania 17356
Pack Leaders or one designated person per pack is responsible for registering cub scouts in the Official District Race. When registering your Pack, please include the "List of Competitors Form" with individual entry details (see pages below). All registrations for the Official District Race will be accepted until Monday, March 25, 2019. All other events can be pre-registered or registered at the race on race day.
Step 1: Person Submitting Registration
Name: ______
Address: ______
City/State/Zip: ______
Phone: ______
Email: ______
Pack Number: ______Scouting Position: ______
Step 2: Number of People Registering x Entry Fee per Person
Official District Race: $6 per racer All other events: $4 per racer All Official District Race Registrations are due in by Monday, March 25, 2019.
Race Registration # of Racers $ per Racer Total
Official District Race ______X $ 6.00 = ______
Outlaw Race ______X $ 4.00 = ______
Demolition Derby ______X $ 4.00 = ______
GRAND TOTAL ______
The $6 registration fee for the Official District Race includes a custom Derby Day patch and covers the cost of the trophies for 1 st , 2 nd & 3 rd place in all ranks and the district championships. The $4 registration fee for all other events covers the costs of the trophies for 1st , 2 nd , and 3 rd for that event.
Step 3: Registration Submittal and Payment
Send personal or Pack check payable to NBOF , to:
Heritage Tails District Derby Day York Service Center Attn: John Blasius 2139 White Street York, PA 17404
LIST OF COMPETITORS
Step 4: Provide the Names of People Registering
Official District Race (Packs may register up to three racers from each rank OR the top 18 fastest racers): (Please circle the appropriate rank for each name registered)
1. Lion Tiger Wolf Bear Web AOL - Name: ______
2. Lion Tiger Wolf Bear Web AOL - Name: ______
3. Lion Tiger Wolf Bear Web AOL - Name: ______
4. Lion Tiger Wolf Bear Web AOL - Name: ______
5. Lion Tiger Wolf Bear Web AOL - Name: ______
6. Lion Tiger Wolf Bear Web AOL - Name: ______
7. Lion Tiger Wolf Bear Web AOL - Name: ______
8. Lion Tiger Wolf Bear Web AOL - Name: ______
9. Lion Tiger Wolf Bear Web AOL - Name: ______
10. Lion Tiger Wolf Bear Web AOL - Name: ______
11. Lion Tiger Wolf Bear Web AOL - Name: ______
12. Lion Tiger Wolf Bear Web AOL - Name: ______
13. Lion Tiger Wolf Bear Web AOL - Name: ______
14. Lion Tiger Wolf Bear Web AOL - Name: ______
15. Lion Tiger Wolf Bear Web AOL - Name: ______
16. Lion Tiger Wolf Bear Web AOL - Name: ______
17. Lion Tiger Wolf Bear Web AOL - Name: ______
18. Lion Tiger Wolf Bear Web AOL - Name: ______
Demolition Derby (This race is open to all Scouts and their Family Members):
1. Racer Name: ______
2. Racer Name: ______
3. Racer Name: ______
4. Racer Name: ______
5. Racer Name: ______
6. Racer Name: ______
7. Racer Name: ______
8. Racer Name: ______
Outlaw Race (This race is open to all Scouts and their Family Members):
1. Racer Name: ______
2. Racer Name: ______
3. Racer Name: ______
4. Racer Name: ______
5. Racer Name: ______
6. Racer Name: ______
7. Racer Name: ______
8. Racer Name: ______
If more space is needed for registration, please indicate so on the back of these sheets. All Derby Day events this year are being hosted by Pack 28 in Red Lion, PA.
Please attach the "List of Competitors" to your Pack Registration Form and send/deliver to:
Heritage Trails District Derby Day York Service Center Attn: John Blasius 2139 White Street York, PA 17404
Remember, Official District Race entries must be received no later than Monday, March 25, 2019.