Big Bend Open Road Race
U.S. Highway 285
Fort Stockton - Sanderson,TX

Version 7.0 2007

Entry Application - Form A

 

BBORR
P.O. Box 416
Fort Stockton, TX 79735


Entrant(s) Information
Driver: _____________________________________________ Age: ____________________________
Address: _________________________________________________________________________________
City: ________________________ State: __________ Zip: _____________________________
Home Phone: ______________________________         Work Phone: _______________________________
Email Address: ________________________________________________              T-Shirt Size__________



Co-Driver/Navigator: _____________________________________________   Age: ____________________
Address: _________________________________________________________________________________
City: ________________________ State: __________ Zip: _____________________________
Home Phone: ______________________________         Work Phone: ____________________________
Email Address: ________________________________________________              T-Shirt Size________

Navigator Drives Return Leg as Driver: _____

Entrant(s) Competition Information
Driver # 1
Competition History: _____________________________________________________________________
______________________________________________________________________________________
Competition License Date & Club Must be accompanied by a photocopy of license): ___________________
State Drivers License (Photocopy please): ____________________________________________________
Valid automobile insurance (Photocopy please): ________________________________________________
Driver # 2
Competition History: _____________________________________________________________________
______________________________________________________________________________________
Competition License Date & Club (Must be accompanied by a photocopy of license): __________________
Valid State Drivers License (Photocopy please): _______________________________________________
Car Number Choice (01 thru 200 - No. 1 NA, 1st entry received gets 1st choice): 1st: _______ : _______ : _______ Lifetime # may be purchased
Installed Safety Equipment Racing Harness Roll Bar Roll Cage
 Fuel Cell Fire Extinguisher Fire System Helmet & Date SA_____ M_____
I certify that the enclosed and attached information above is correct and understand that any misrepresentation is grounds for disqualification from the event and forfeiture of my entry fee. I have read and understand the rules and regulations for this event. I understand that safety of my person and my vehicle is my responsibility and I also certify that I have reviewed and accept the terms of the Big Bend Open Road Race refund/transfer policy as outlined in this entry package.


Driver: ___________________________________ Co-Driver/Navigator: _________________________