Limited Weld Stock Car $ 75.00     Stock $ 75.00    Full Size Truck $ 75.00      Full Weld Compact $ 75.00      90’s Newer $ 75.00

Farm Truck  $ 50.00      Warrior South $ 50.00

Vehicle #  ___________________________________________

Driver: (Please Print Legibly)

Social Security number: _______-_____-_______ Date of Birth: ______/______/______

Driver Name: __________________________________________________________________

Address: ___________________________________________________City, State, Zip: _______________________________

Home #: (____)__________________ Work #: (____)_______________________E-mail _______________________________

Signature_________________________________________________________________________________

Owner: (If same as driver just mark "Same")

SSN/Fed ID: ________________________ Date of Birth: ________/_______/_______

Name / Company Name:__________________________________________________________

Address: _______________________________________________City, State, Zip: ___________________________________

Home #: (___)____________________________________ Work #: (____)__________________________________________

Email_________________________________________________________________________________________________

Signature_______________________________________________________________________________________________

Sponsors: Main (for announcer):____________________________________________________________________________

Other: _________________________________________________________________________________________________

I will abide by the rules of C.R.A. as listed in the 2024 Demo Derby / Farm Truck / Warrior South for this event.  I will not hold C.R.A., its promoter, the City of Pueblo, or any track officials responsible for any physical injury or damage to my vehicle(s).

I understand a breathalyzer test may be required at any time.  I understand refusal to take the test or failure of the breathalyzer test will result in disqualification with no pay or points.

________________________________________________             __________________ _________________

(Participant)                                                                                                            (Promoter)

Make check/money order payable to C.R.A.     18245 E. Hwy. 94     Colo. Springs, CO 80930