CENTRAL MONTANA FAIR DEMOLITION DERBY REGISTRATION

NAME:______________________________________________________
ADDRESS:___________________________________________________
	        ___________________________________________________
CAR COLOR:________________________________________________
CAR MAKE:_________________________________________________
NUMBER:___________________________________________________
NAME OF CAR:______________________________________________
NAME OF SPONSORS: ( no more than 4)
1)___________________________________________________________
2)___________________________________________________________
3)___________________________________________________________
4)___________________________________________________________


I __________________________________ release all liability and responsibility from the Central Montana Fair, Central Montana Derby Club, MSU Nursing students, Lewistown Volunteer Fire Department, and all its members in case of any and all accidents, injuries, dismemberment or loss of life from the Central Montana Fair Demolition. I realize I must be at lease 18 years of age to participate and or be in the pit area. If I show false information and/or lie, I realize all responsibility is mine and may be punishable by law.

		Signed by participant	_________________________________________
		Pit Man			_________________________________________
		Pit Man			_________________________________________

Signed by Witness	____________________________________ Date __________________