Entry Form
The cost is $40 for each class per race entered.
Racers registering the morning of the race will be charged a late registration fee of $20.
Annual UMPBA membership dues are required to race
(see membership form)

Select One

July 25th - Racing the Liquid Quarter Mile, Carter Lake, IA
August 15th - Chain of Lakes, Fairmont, MN
Driver's First Name:
Driver's Last Name:
Owner's Name (if different than driver):
Boat Weight:
Race number:
Boat Make:
Boat Color:
Motor:
Class:

Emergency
Contact Person:
Emergency
Phone number:

Emergency Contact Person at Race?

AGREEMENT OF RELEASE
In consideration of their promotional efforts on behalf of the sport, I hereby assign all commercial communication and broadcast rights to the Upper Midwest Power Boat Association, Inc. and do declare them as my lawful agents’ and representatives regarding such rights. I, the undersigned participating in events sanctioned by the UMPBA, agree that UMPBA and its assigns may use my name and picture and pictures of my race boat, or any of them, in any way, medium, or material for promoting, advertising, recording or reporting any UMPBA sanctioned event before, during and after such event and do hereby relinquish all rights hereto for these purposes.

Signed ________________________________________ Dated ___________



Please mail signed and completed form along with your payment to:
The Upper Midwest Power Boat Association
61456 County Road 21
New Ulm, MN 56073

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