10th Annual Nezperce Lions Club

Combine Demolition Derby

Sunday- September 27, 2009-Lewis County Fair-Nezperce ID

For any questions phone J.P. at 208-937-2171 or Jim at 208-937-2567

Regristration: 10:00 am to 1:00 pm-Derby sarts at 1:00 pm

Must be at least 18 years old to participate, including driving and pit crew.

ENTRY FORM

Entry Fee: $100 (non-refundable after Oct 12, 2009)

Age

Name:

Address:

City:

State:

Zip:

Phone:

Cell:

Email:

Combine:Make

Model No.

Driver:

Pit Crew (1):

Pit Crew (2):

Pit Crew(3):

Sponsor:

Nezperce Lions Club has the right to refuse any entry

Mail Entry: Nezperce Lions Club, PO Box 154, Nezperce ID 83543