July 2nd, 2011
Harris Motor Speedway
921 Jack McKinney Rd
Rutherfordton NC 28139

Demolition Derby

 

HARRIS ENTRY FORM- July 2nd
                                      NAME__________________________________________________

Phone#____________________Cellphone#____________________

Age_____Date of Birth_____________________________________

Driver’s License#___________________Exp. Date______________

SocialSecurity#___________________________________________

Address_________________________________________________

City, State, Zip____________________________________________

Car name/number-       1st choice_______________________________

2nd choice______________________________

I have read the rules and will accept the decision of the judges
as final and elect to use the ground or track in its present condition.
 DISCLAIMER: Ultimate Destruction does not imply or guarantee safety. 
Total responsibility for inspection of car safety and rule compliance is by the
owner/driver, not Ultimate Destruction.
ALL drivers, pit crew members and others entering the infield/pit area MUST
Sign a WAIVER & RELEASE.

Gates open @ 4:00pm  
All entrants MUST be on grounds for inspection by 8:00pm
 ENTRY FEE  $50.00 AT GATE OR MAIL-IN
*INCLUDES CAR & DRIVER  (no pit crew included)

Please mail money order or checks to:
Ultimate Destruction
1880 Oak Grove Ch. Rd.
Ellenboro, NC 28040

Phone#- 828.447.5400
Email- ultimatedestruction@nctv.com