<p>Saturday Night April 19th – 2014 SMASH FOR CASH DEMO DERBY ENTRY FORM</p><p>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. </p><p>I HAVE READ THE RULES AND ACCEPT THE DECISION OF THE JUDGES AS FINAL: </p><p>Driver Signature: Date:</p><p>Please print clearly when filling out this entry form:</p><p>Drivers Name: ______Age: ______</p><p>Address: ______E-MAIL: ______</p><p>City: ______State: ______Zip: ______</p><p>Home Phone: ( ) ______Cell Phone: ( ) ______</p><p>Driver License Number: ______State Issued In: ______</p><p>Credit Card or Debit Card Information (Visa, Discover, Amex & MasterCard) Name as it appears on card: ______</p><p>Visa ____ MasterCard ____ Amex____ Discover ____</p><p>Card number: ______</p><p>Expiration Date: Month ____ Year ____ Security code _ _ _ (3 digit number on back of card)</p><p>Pre-entry fee per class - check the classes you are entering:</p><p>MAIN EVENT (OPEN CLASS) ($35 ea) ______80’s & NEWER ($25 ea) ______</p><p>JUMP YOUR JUNK ($20 ea) ______Tuff Trucks ($25 ea) ______</p><p>Additional Pit Passes $10 each in advance ______</p><p>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 on- site registration – bring cash.)</p><p>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.)</p><p>Total the amount being charged to your credit card: $______</p><p>CASH ONLY - NO CHECKS ACCEPTED FOR ENTRY FEES OR PIT PASSES DAY OF</p><p>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</p><p>Main Event</p><p>1st = $1,200 2nd = $600 3rd = $350</p><p>80's Newer class 1st= $650 2nd= $250 3rd= $100</p><p>Jump “ur” Junk</p><p>$500 for 1st (audience vote)</p><p>Tuff Truck</p><p>100% of registration fee’s pay out</p><p>1st = 60% 2nd = 30% 3rd = 10%</p>