Smash for Cash Demo Derby Entry Form

Saturday Night April 19th – 2014 SMASH FOR CASH DEMO DERBY ENTRY FORM

After reading through the rules for this derby and filling out this paper work you are hereby agreeing to the rules and procedures for this Derby at the Ranch & Home Arena inside TRAC Center on Saturday April 19, 2014.

I HAVE READ THE RULES AND ACCEPT THE DECISION OF THE JUDGES AS FINAL:

Driver Signature: Date:

Please print clearly when filling out this entry form:

Drivers Name: ______Age: ______

Address: ______E-MAIL: ______

City: ______State: ______Zip: ______

Home Phone: ( ) ______Cell Phone: ( ) ______

Driver License Number: ______State Issued In: ______

Credit Card or Debit Card Information (Visa, Discover, Amex & MasterCard) Name as it appears on card: ______

Visa ____ MasterCard ____ Amex____ Discover ____

Card number: ______

Expiration Date: Month ____ Year ____ Security code _ _ _ (3 digit number on back of card)

Pre-entry fee per class - check the classes you are entering:

MAIN EVENT (OPEN CLASS) ($35 ea) ______80’s & NEWER ($25 ea) ______

JUMP YOUR JUNK ($20 ea) ______Tuff Trucks ($25 ea) ______

Additional Pit Passes $10 each in advance ______

You can do onsite registration the day of the event prices are: Main Event $50, 80’s & Tough Truck $40, Jump Your Junk $35 and $20 per pit pass but can only be done with cash. (No checks, no credit cards at onsite registration – bring cash.)

Pre entry drivers receive first option for your CAR NUMBER #______or ______(Remember no obscene slogans, drawings, or use of anything like that in your car or on your car.)

Total the amount being charged to your credit card: $______

CASH ONLY - NO CHECKS ACCEPTED FOR ENTRY FEES OR PIT PASSES DAY OF

CREDIT CARDS MAY ONLY BE USED FOR PRE-ENTRY FEES PIT PASSES SOLD DAY OF FOR CASH ONLY AT REGISTRATION Questions e-mail: Dan Nelson [email protected] ; 509-438-2164 Payout Schedule

Main Event

1st = $1,200 2nd = $600 3rd = $350

80's Newer class 1st= $650 2nd= $250 3rd= $100

Jump “ur” Junk

$500 for 1st (audience vote)

Tuff Truck

100% of registration fee’s pay out

1st = 60% 2nd = 30% 3rd = 10%