Combine Derby

2011

FAIRFIELD COUNTY AGRICULTURAL SOCIETY

FAIRFIELD COUNTY FAIR

P.O. BOX 945

LANCASTER, OH  43130

COMBINE DEMOLITION DERBY ENTRY FORM

COMBINE DEMO DERBY DATE:  THURSDAY OCTOBER 13 AT 7:30 PM

MUST BE 18 YEARS OF AGE OR OLDER TO PARTICIPATE

NAME _____________________________________________________________

ADDRESS __________________________________________________________

___________________________________________________________________

PHONE ____________________________________________________________

SIGNATURE ________________________________________________________

MAKE OF COMBINE _________________________________________________

MODEL/SIZE ________________________________________________________

NUMBER OF YEARS IN DERBY ________________________________________

NOTICE:  (1) All drivers are required to sign a release and waiver of liability agreement before entering the track or exhibition area.  Get Form Here.

(2)  All equipment must be removed from the fairgrounds within 12 hours of completion of derby event. Failure to comply will result in not being paid prize money or to enter next year.