Street Class and 4-Wheel Drive Mud Bog
Registration Form
Please print clearly:
Name: _________________________________ Phone: ___________
Address: __________________________________________________
City: ______________________ State: _______ Zip: _________
Truck Name: _______________________________________________
Year: ____ Make: _________ Engine: _____ Tire Size: _________
Sponsor(s): ________________________________________________
Comments: ________________________________________________
Class (circle one): Street Super Street Modified
Super Modified Little Outlaw Big Outlaw
Waiver
All medical bills and services arising from this event by the driver and/or crew shall be the team’s responsibility
alone. All vehicle damage arising from this event shall also be the team’s responsibility alone. All race members
hereby release, waive, discharge not to sue the promoter, participants, track owner(s), track operator(s) and each
of their officers and employees and release same for all liabilities.
Signature: ___________________________________ Date: _________
