NAME OF ENTRANT:...............................................................................................

ADDRESS: ...........................................................................................................

SUBURB: ............................................................... POSTCODE: …………

TELEPHONE: (HOME) ……………………………….. (WORK) ………………………………….

CURRENT DRIVERS LICENCE NO. ……………………..

MAKE AND MODEL OF CAR: …………………………………………………………………………..

PREFERRED CAR NUMBER: ………………………………….

SPONSORS: ……………………………………………………………………………………………

ARE YOU TAKING YOUR CAR AWAY AFTER THE EVENT ........ YES / NO

ENTRY PER CAR: $55

ENTRIES MUST BE RECEIVED BY LAST MAIL ON THE MONDAY BEFORE THE EVENT.

ENTRIES RECEIVED AFTER THAT DATE MAY NOT BE ACCEPTED.

THERE IS TO BE NO ALCOHOL TO BE BROUGHT INTO THE PITS AND/OR CONSUMED BY ENTRANTS AND/OR THEIR CREWS PRIOR TO AND/OR DURING THE RUNNING OF THE DEMOLITION DERBY. BREAK THIS RULE AND THE OFFENDING TEAM WILL BE REMOVED FROM THE PITS AND THEIR ENTRY WITHDRAWN WITHOUT ANY REFUND BEING GIVEN.

PAINTING OF CARS: CARS MUST NOT CARRY OBJECTIONABLE OR PROFOUND SIGNAGE.

PLEASE READ AND ACKNOWLEDGE: Nowra Speedway and all of its Officers, Officials, Employees, Representatives or Agents, collectively and /or individually are absolutely indemnified, from all claims concerning any personal loss, injury or damage incurred, sustained or made by me arising directly or indirectly from my participation in the Demolition Derby at the Nowra Speedway. I understand that the decision to participate is solely mine and hereby give my signature in recognition of the above. I have read all the above conditions and rules attached to this entry form and agree to be bound by them and I accept the Judges decision, or any of his decisions to be final.

SIGNATURE OF ENTRANT: ……………………………………………………………

WITNESSED BY: ………………………………………………………………………….

PLEASE FAX COMPLETED FORM TO 02 4256 5654 or email to: office@nowraspeedway.com

PLEASE NOTE - No entry forms will be accepted on the day. You must pre-enter.