<p> Grande Prairie</p><p>Sled Dog Derby </p><p>2011 RACE ENTRY FORM</p><p>January 1-2, 2011 </p><p>Entry Fees Amount Estimated Purse 10 Dog Distance * Approx. 40 miles $80.00 $3,000 10 Dog Class * Approx. 10 miles $75.00 $3,000 6 Dog Class – Open * Approx. 6 miles $70.00 $3,000</p><p>4 Dog Class – Open * Approx. 4 miles $60.00 $2000 </p><p>2 Dog Skijoring * Approx. 4 miles $41.00 $1,000 All entries Includes Dinner Ticket TOTAL $ </p><p>Please make cheques payable to Evergreen Park, Sled Dog Derby and mail to:</p><p>Evergreen Park C/O Les Butler, Manager</p><p>Address Box 370</p><p>Grande Prairie, AB, Canada T8V-3A5</p><p>Or email to Irvin Wai at: [email protected]</p><p>Team Owner______</p><p>Team Driver______</p><p>Participation, placement and mileage in previous Sled Dog Derby races: </p><p>Other racing experience: </p><p>Please write a short paragraph about yourself. The Grande Prairie Sled Dog derby will use this information in publicity releases: (You may wish to include occupation, number of years in the sport, number of dogs in your kennel, etc.) Kennel Name: </p><p>NOTE: This Entry Form must be completed in its entirety and must be accompanied by full payment before your entry will be registered. </p><p>Mailing Address______</p><p>Telephone Number______</p><p>E-Mail______</p><p>Entry Fees Enclosed $______</p><p>AGREEMENT – I agree to be responsible for my conduct and the conduct of my dogs and my dog handlers and to accept the decision of race officials as final. I shall not hold the sponsors, officials, or any other persons involved with this race liable for any injury or damage to myself, my dogs or my equipment. I understand and agree to abide by the ISDRA Race Rules governing this race. Further, I give the Grande Prairie sled dog derby the unqualified and unrestricted authority to release my name, address and to otherwise collect information and photographs for advertising, public relations, or other publicity purposes</p><p>Owners Signature______Drivers Signature______</p><p>Office Use Only </p><p>Payment Amount Received: ______Check#: ______Date: ______Initials: ______Receipt#: ______</p>